{ "hospital_name": "Garden City Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Garden City Hospital" ], "hospital_address": [ "6245 Inkster Road Garden City, MI 48135" ], "license_information": { "license_number": "464719451", "state": "MI" }, "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": "Saju George" }, "type_2_npi": [ "1043625940", "1861807760", "1407480247" ], "standard_charge_information": [ { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9366, "minimum": 7893.07, "maximum": 14986.032, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 14075.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12176.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8366.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 12234.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14986.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11977.25 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9669.41 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9366.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7893.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8287.72, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5915.85, "maximum": 10648.53, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5915.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6507.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6507.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5915.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6507.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5915.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5915.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10648.53, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5915.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5915.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5404.2, "minimum": 1080.55, "maximum": 5404.2, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5404.2 } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4114.78, "maximum": 7406.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4526.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4526.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4526.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7406.6, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4114.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2500.24, "maximum": 4500.43, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2500.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 2750.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 2750.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2500.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2750.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2500.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2500.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 4500.43, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2500.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2500.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 1", "code_information": [ { "code": "5431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3153.34, "maximum": 5676.01, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5676.01, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3153.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4851.09, "maximum": 8731.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4851.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5336.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5336.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4851.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5336.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4851.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4851.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8731.96, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4851.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4851.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8907.84, "maximum": 16034.11, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9798.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9798.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9798.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16034.11, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8907.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6848.46, "maximum": 12327.23, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6848.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7533.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7533.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6848.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7533.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6848.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6848.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12327.23, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6848.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6848.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3864.09, "maximum": 6955.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3864.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4250.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4250.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3864.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4250.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3864.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3864.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6955.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3864.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3864.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 4", "code_information": [ { "code": "5644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9044.33, "maximum": 16279.79, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16279.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9044.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9044.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9044.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9948.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9948.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9044.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9948.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9044.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9044.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 3", "code_information": [ { "code": "5433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5801.11, "maximum": 10442, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5801.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6381.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6381.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5801.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6381.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5801.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5801.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10442, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5801.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5801.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11480.55, "maximum": 20664.99, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11480.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12628.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12628.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11480.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12628.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11480.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11480.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20664.99, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11480.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11480.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 4", "code_information": [ { "code": "5434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13371.89, "maximum": 24069.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13371.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14709.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14709.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13371.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14709.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13371.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13371.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24069.4, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13371.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13371.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12262.54, "maximum": 22072.57, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12262.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13488.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13488.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12262.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13488.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12262.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12262.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22072.57, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12262.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12262.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3468.75, "maximum": 6243.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3815.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3815.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3815.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6243.75, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3468.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3468.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8721, "minimum": 7356.05, "maximum": 19214.814, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19214.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11338.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7797.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11401.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13955.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11105.27 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8721.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12309.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8721.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7723.85, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7941, "minimum": 5196.06, "maximum": 12706.88, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9016.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10324.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7108.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10393.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12706.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10049.33 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7941.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5196.06 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7941.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7041.03, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14743.35, "maximum": 26538.03, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14743.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16217.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16217.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14743.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16217.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14743.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14743.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26538.03, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14743.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14743.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 4", "code_information": [ { "code": "7564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13107.06, "maximum": 23592.71, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13107.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14417.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14417.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13107.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14417.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13107.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13107.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23592.71, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13107.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13107.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4861.42, "maximum": 8750.56, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4861.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5347.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5347.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4861.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5347.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4861.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4861.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8750.56, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4861.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4861.42, "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": 15784.73, "maximum": 28412.51, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15784.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17363.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17363.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15784.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17363.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15784.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15784.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28412.51, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15784.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15784.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4087.05, "maximum": 7356.69, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4087.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4495.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4495.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4087.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4495.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4087.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4087.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7356.69, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4087.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4087.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3449.71, "maximum": 6209.48, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3794.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3794.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3794.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6209.48, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48969, "minimum": 40903.1, "maximum": 172449.567, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 172449.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 63659.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 43357.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 63399.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 78350.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 65576.86 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48969, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103158 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 48969, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40903.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 42948.26, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8938.83, "maximum": 16089.89, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8938.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9832.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9832.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8938.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9832.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8938.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8938.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16089.89, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8938.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8938.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8175.34, "maximum": 14715.61, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8992.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8992.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8992.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14715.61, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8175.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8175.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10783, "minimum": 5469.07, "maximum": 18450, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 10768.9 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14018.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9618.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14065.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17253.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13895.62 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10783.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5469.07 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10783.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9074.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9528.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10315.73, "maximum": 18568.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10315.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11347.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11347.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10315.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11347.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10315.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10315.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18568.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10315.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10315.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5554.22, "maximum": 9997.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5554.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6109.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6109.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5554.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6109.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5554.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5554.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9997.6, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5554.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5554.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7451, "minimum": 3507.09, "maximum": 12150, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9553.66 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9687.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6675.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9761.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11923.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9386.38 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7451.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3507.09 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7451.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6297.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6612.32, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7739.75, "maximum": 13931.55, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7739.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8513.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8513.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7739.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8513.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7739.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7739.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13931.55, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7739.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7739.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6685.87, "maximum": 12034.57, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7354.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7354.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7354.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12034.57, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6685.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7573.89, "maximum": 13633, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8331.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8331.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8331.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13633, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7573.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7573.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3351.29, "maximum": 6032.32, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3351.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3686.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3686.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3351.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3686.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3351.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3351.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6032.32, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3351.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3351.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8991, "minimum": 7441.23, "maximum": 17015.697, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17015.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11688.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8035.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11749.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14385.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11469.59 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8991.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7441.23 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8991.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7580.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7959.44, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13399.62, "maximum": 24119.32, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13399.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14739.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14739.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13399.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14739.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13399.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13399.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24119.32, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13399.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13399.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26927.19, "maximum": 48468.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26927.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 29619.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 29619.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26927.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 29619.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 26927.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26927.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 48468.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 26927.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26927.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8628, "minimum": 7278.07, "maximum": 18403.875, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 18403.88 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11216.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7714.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11281.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13805.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10978.65 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8628.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11633.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8628.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7278.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.97, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15581, "minimum": 8723.54, "maximum": 24930.128, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 22416.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20255.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13857.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 20263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24930.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20388.92 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15581.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8723.54 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15581.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13073.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.18, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14674, "minimum": 12317.3, "maximum": 26461.851, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 26461.85 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19076.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18450, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 45000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13056.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19091.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23478.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19160.97 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14674.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17256.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14674.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12317.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12933.17, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18925, "minimum": 15860.9, "maximum": 83208.885, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 83208.89 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24603.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16812.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 24584.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30280.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24914.88 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22859.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18925.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15860.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16653.95, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24400, "minimum": 20424.8, "maximum": 63187.806, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 63187.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 31721.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 21650.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 31658.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 39041.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32325.56 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24400.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33870.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 24400.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20424.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 21446.04, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6715.78, "maximum": 12088.4, "payers_information": [ { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6715.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7387.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6715.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6715.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12088.4, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6715.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6715.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6715.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7387.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7387.36, "additional_payer_notes": "110% 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": 11279, "minimum": 9487.96, "maximum": 23835.063, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 23835.06 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14663.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10057.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14706.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18047.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14566.93 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11279.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15977.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11279.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9487.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9962.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3228.39, "maximum": 5811.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3228.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3551.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3551.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3228.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3551.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3228.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3228.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5811.1, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3228.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3228.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5189.33, "maximum": 9340.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5189.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5708.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5708.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5189.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5708.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5189.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5189.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9340.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5189.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5189.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12866, "minimum": 6750, "maximum": 34592.274, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 34592.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16726.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11459.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 16756.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20586.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16714.64 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12866.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18676.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12866.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10810.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11351.24, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6898, "minimum": 5836.2, "maximum": 15968.721, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15968.72 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8968.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6186.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9046.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11037.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8637.43 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6898.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10435.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6898.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5836.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6128.01, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3339.32, "maximum": 6010.78, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3339.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3673.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3673.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3339.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3673.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3339.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3339.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6010.78, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3339.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3339.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12210.88, "maximum": 21979.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13431.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13431.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13431.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21979.58, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12210.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3263.73, "maximum": 5874.71, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3590.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3590.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3590.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5874.71, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3263.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11016, "minimum": 9268.73, "maximum": 27943.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 16230.47 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14321.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 19800, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 21000, "10th_percentile": 21000, "90th_percentile": 21000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9824.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14366.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17626.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14210.97 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11016.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27943.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11016.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9732.17, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 2", "code_information": [ { "code": "7552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3814.06, "maximum": 6865.31, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4195.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4195.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4195.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3814.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6865.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3814.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8542.95, "maximum": 15377.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8542.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9397.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9397.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8542.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9397.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8542.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8542.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15377.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8542.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8542.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4342.63, "maximum": 7816.73, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4342.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4776.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4776.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4342.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4776.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4342.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4342.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7816.73, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4342.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4342.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10455, "minimum": 8800.86, "maximum": 17868.702, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17868.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13591.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9328.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13641.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16728.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13451.26 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10455.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17668 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10455.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9240.9, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32449, "minimum": 18450, "maximum": 70801.752, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 70801.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 42184.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 28762.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 42057.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 51919.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43219.4 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32449.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44853.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 32449.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 28490.7, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7611, "minimum": 6430.6, "maximum": 13615.362, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13615.36 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9895.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6816.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9967.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12178.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9602.59 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7611.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11317.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7611.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6430.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6752.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38726.56, "maximum": 69707.81, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 38726.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 42599.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 42599.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 38726.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 42599.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 38726.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 38726.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 69707.81, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 38726.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 38726.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16975, "minimum": 14235.8, "maximum": 44454.414, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 44454.41 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22068.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 22950, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15089.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 22065.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27161.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22276.23 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23340.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16975.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14947.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3424.16, "maximum": 6163.49, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3424.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3766.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3766.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3424.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3766.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3424.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3424.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6163.49, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3424.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3424.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40783, "minimum": 19350, "maximum": 85564.581, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 85564.58 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53018.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 36124.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 52823.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 65253.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54497.87 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40783.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61445.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40783.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34079.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 35783.9, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5052.84, "maximum": 9095.11, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5558.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5558.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5558.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9095.11, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5052.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13010, "minimum": 8337.26, "maximum": 34200, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 21820.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16913.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11586.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 16942.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20816.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16909.34 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13010.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8337.26 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13010.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11477.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4110.98, "maximum": 7399.76, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4110.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4522.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4522.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4110.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4522.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4110.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4110.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7399.76, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4110.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4110.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6625, "minimum": 5608.89, "maximum": 15312.024, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15312.02 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8613.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5945.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8693.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10601.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8268.33 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6625.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9317.12 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6625.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5889.33, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14321.91, "maximum": 25779.44, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14321.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15754.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15754.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14321.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15754.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14321.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14321.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 25779.44, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14321.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14321.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15918, "minimum": 13279.6, "maximum": 25469.568, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 24080.45 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20694.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 14155.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 20699.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25469.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20845.22 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15918.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13279.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15918.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14022.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Alcohol Absolute Inj 98%", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "00517857510", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17998, "minimum": 14400, "maximum": 40514.232, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 40514.23 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23398.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15993.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 23387.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28797.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23660.66 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32031.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17998.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15088.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15842.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1881.4, "maximum": 3386.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 1881.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 2069.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 2069.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 1881.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2069.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 1881.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 1881.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 3386.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 1881.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 1881.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8308, "minimum": 7011.03, "maximum": 14850, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 11462.99 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10800.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7431.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13292.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10545.05 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8308.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8308.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7011.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7361.58, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6543.94, "maximum": 11779.09, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7198.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7198.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7198.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11779.09, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5802, "minimum": 4922.53, "maximum": 10114.536, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 10114.54 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7543.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5217.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7629.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9283.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7153.86 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5802.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7059.49 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5802.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4922.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5168.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15358, "minimum": 12887.4, "maximum": 30222.084, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 30222.08 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19965.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13660.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19975.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24572.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20086.71 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17442.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15358.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12887.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13531.77, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4687.95, "maximum": 8438.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4687.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5156.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5156.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4687.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5156.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4687.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4687.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8438.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4687.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4687.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12842.23, "maximum": 23116.01, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12842.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14126.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14126.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12842.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14126.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12842.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12842.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23116.01, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12842.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12842.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 3", "code_information": [ { "code": "7553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6565.69, "maximum": 11818.24, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6565.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7222.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7222.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6565.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7222.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6565.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6565.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11818.24, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6565.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6565.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 3", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61506.89, "maximum": 110712.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 61506.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 67657.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 67657.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 61506.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 67657.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 61506.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 61506.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 110712.4, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 61506.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 61506.89, "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": 10121.05, "maximum": 18217.89, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11133.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11133.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11133.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18217.89, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10121.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5961, "minimum": 4370.27, "maximum": 9538.096, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9182.07 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7749.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5358.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9538.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7368.87 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5961.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4370.27 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5961.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5054.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5307.69, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19860, "minimum": 12150, "maximum": 56690.946, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 56690.95 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25819.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 25793.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31777.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26181.05 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19860.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30796.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19860.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 17472.74, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6340.56, "maximum": 11413.01, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6340.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6974.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6974.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6340.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6974.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6340.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6340.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11413.01, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6340.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6340.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17176.86, "maximum": 30918.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17176.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18894.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18894.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17176.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18894.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17176.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17176.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30918.35, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 17176.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17176.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 3", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7327.01, "maximum": 13188.62, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13188.62, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7327.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7327.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7327.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8059.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8059.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7327.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8059.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7327.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7327.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5432.95, "maximum": 9779.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5432.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5976.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5976.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5432.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5976.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5432.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5432.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9779.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5432.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5432.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2552.44, "maximum": 4594.39, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2552.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 2807.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 2807.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2552.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2807.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2552.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2552.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 4594.39, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2552.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2552.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28077.87, "maximum": 50540.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28077.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 30885.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 30885.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28077.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 30885.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 28077.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28077.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 50540.17, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 28077.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28077.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 59109.82, "maximum": 106397.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 59109.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 65020.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 65020.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 59109.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 65020.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 59109.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 59109.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 106397.68, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 59109.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 59109.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6056, "minimum": 5134.39, "maximum": 22309, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9841.11 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7873.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5442.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7958.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9690.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7497.88 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6056.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22309 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6056.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5391.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20601, "minimum": 17257.9, "maximum": 35891.646, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 35891.65 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26781.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 18293.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 26749.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32962.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27183.24 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20601.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23685.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20601.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17257.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 18120.8, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 128604.2, "maximum": 231487.56, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 128604.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 141464.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 141464.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 128604.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 141464.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 128604.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 128604.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 231487.56, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 128604.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 128604.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10932, "minimum": 9198.85, "maximum": 19932.273, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19932.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14212.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9750.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14258.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17492.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14097.49 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10932.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9746.45 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10932.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9658.79, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3604.15, "maximum": 6487.47, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3604.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3604.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3964.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3604.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3604.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6487.47, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3604.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3604.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14885.28, "maximum": 26793.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14885.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16373.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16373.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14885.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16373.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14885.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14885.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26793.5, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14885.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14885.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5216.52, "maximum": 9389.74, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5216.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5738.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5738.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5216.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5738.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5216.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5216.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9389.74, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5216.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5216.52, "additional_payer_notes": "100% of State Medicaid 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": 12735, "minimum": 10701, "maximum": 20530.545, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20530.55 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16555.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11343.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 16586.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20376.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16536.66 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12735.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18985.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12735.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10701, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11236.05, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12067, "minimum": 10144.9, "maximum": 22133.727, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 22133.73 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15688.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10753.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15724.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19308.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15633.62 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12067.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15222.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12067.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10144.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10652.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4113.69, "maximum": 7404.64, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4113.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4113.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4525.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4113.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4113.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7404.64, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4113.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4113.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6397, "minimum": 5003.5, "maximum": 10761.885, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 10761.89 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8316.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8398.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10235.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7958.95 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6397.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5003.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6397.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5418.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5689.27, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38404, "minimum": 32097.4, "maximum": 74847.099, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 74847.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 49926.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 34023.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 49750.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 61447.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51278.69 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38404.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65343.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 38404.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32097.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 33702.27, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6091.67, "discounted_cash": 3245, "minimum": 1218, "maximum": 6091.67, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2663.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 106583, "minimum": 88926.2, "maximum": 326836.461, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 326836.46 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 138558.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 94261.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 137835.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 170533.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 143553.82 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 106583.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 133048 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 106583.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 88926.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 93372.51, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10153.14, "maximum": 18275.65, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10153.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11168.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11168.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10153.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11168.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10153.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10153.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18275.65, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10153.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10153.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7034.99, "maximum": 12662.98, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7034.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7738.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7738.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7034.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7738.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7034.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7034.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12662.98, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7034.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7034.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50716.81, "maximum": 91290.26, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50716.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 55788.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 55788.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 50716.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 55788.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 50716.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50716.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 91290.26, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 50716.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 50716.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6566.78, "maximum": 11820.2, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6566.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7223.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7223.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6566.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7223.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6566.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6566.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11820.2, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6566.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6566.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8989.41, "maximum": 16180.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8989.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9888.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9888.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8989.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9888.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8989.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8989.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16180.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8989.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8989.41, "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": 11869.91, "maximum": 21365.84, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11869.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13056.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13056.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11869.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13056.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11869.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11869.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21365.84, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11869.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11869.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5551.5, "maximum": 9992.7, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5551.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6106.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6106.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5551.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6106.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5551.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5551.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9992.7, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5551.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5551.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9227.59, "maximum": 16609.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9227.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10150.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10150.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9227.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10150.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9227.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9227.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16609.66, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9227.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9227.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11917.22, "maximum": 21451, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11917.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13108.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13108.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11917.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13108.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11917.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11917.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21451, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11917.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11917.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8200, "minimum": 6921.28, "maximum": 20698.809, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20698.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10660.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7336.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10727.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13120.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10399.32 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8200.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8359.92 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8200.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6921.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7267.34, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3114.19, "maximum": 5605.54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3114.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3425.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3425.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3114.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3425.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3114.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3114.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5605.54, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3114.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3114.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20218.33, "maximum": 36392.99, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20218.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 22240.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 22240.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20218.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22240.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 20218.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20218.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 36392.99, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 20218.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20218.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3193.04, "maximum": 5747.47, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3193.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3512.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3512.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3193.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3512.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3193.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3193.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5747.47, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3193.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3193.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5192.59, "maximum": 9346.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5711.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5711.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5711.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9346.66, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5192.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5192.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31295, "minimum": 26171.7, "maximum": 50072.816, "payers_information": [ { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 27742, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 40566.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 50072.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41656.99 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31295.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27813.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31295.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 27480.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 40553.96 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40684.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 26171.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9602.27, "maximum": 17284.09, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9602.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10562.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10562.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9602.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10562.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9602.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9602.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17284.09, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9602.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9602.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37789, "minimum": 6750, "maximum": 67338.318, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 67338.32 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 49126.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 33479.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 48956.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 60463.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50446.12 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37789.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7769.74 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 37789.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 33163.83, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6046.36, "maximum": 10883.45, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6046.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6651, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6651, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6046.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6651, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6046.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6046.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10883.45, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6046.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6046.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22500, "discounted_cash": 3245, "minimum": 1739.7495, "maximum": 22500, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2663.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6543.94, "maximum": 11779.09, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7198.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7198.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7198.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11779.09, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6543.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3701.49, "maximum": 6662.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3701.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4071.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4071.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3701.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4071.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3701.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3701.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6662.68, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3701.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3701.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2281.09, "maximum": 4105.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2281.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 2509.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 2509.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2281.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2509.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2281.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2281.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 4105.96, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2281.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2281.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12317.46, "maximum": 22171.43, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12317.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13549.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13549.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12317.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13549.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12317.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12317.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22171.43, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12317.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12317.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14605.77, "maximum": 26290.39, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14605.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16066.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16066.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14605.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16066.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14605.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14605.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26290.39, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14605.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14605.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7553.77, "maximum": 13596.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7553.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8309.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8309.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7553.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8309.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7553.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7553.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13596.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7553.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7553.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15662.92, "maximum": 28193.26, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15662.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17229.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17229.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15662.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17229.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15662.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15662.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28193.26, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15662.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15662.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8219.93, "maximum": 14795.87, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8219.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9041.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9041.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8219.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9041.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8219.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8219.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14795.87, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8219.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8219.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25674, "minimum": 21486.4, "maximum": 44410.011, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 44410.01 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 33376.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 22775.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 33303.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 41079.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34049.22 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25674.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23607.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25674.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21486.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 22560.72, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11533.3, "maximum": 20759.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11533.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12686.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12686.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11533.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12686.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11533.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11533.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20759.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11533.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11533.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21653, "minimum": 18134.8, "maximum": 34645.472, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 30722.2 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28149.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 19222.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 28108.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34645.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28607.08 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21653.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32946.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21653.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18134.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 19041.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15349.15, "maximum": 27628.47, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15349.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16884.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16884.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15349.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16884.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15349.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15349.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27628.47, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15349.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15349.15, "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": 43954, "minimum": 36723.1, "maximum": 70326.768, "payers_information": [ { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 38926.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 56920.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 70326.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58789.71 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43954.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44828.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 43954.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 38559.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 59944.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 57140.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 36723.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10619, "minimum": 8550, "maximum": 22624.497, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 22624.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13805.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9473.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13853.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16991.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13673.44 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10619.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19055.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10619.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8937.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9384.57, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8128.03, "maximum": 14630.45, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8128.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8940.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8940.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8128.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8940.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8128.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8128.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14630.45, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8128.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8128.03, "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": 17023, "minimum": 14275.5, "maximum": 27237.536, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 26588.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22130.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15132.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 22127.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27237.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22340.73 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17023.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17219.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17023.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14275.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14989.28, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13034, "minimum": 10950.4, "maximum": 20854.768, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20635.71 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16944.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11607.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 16973.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20854.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16941.59 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13034.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15656.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13034.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10950.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.92, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19008.38, "maximum": 34215.08, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19008.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 20909.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 20909.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19008.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 20909.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19008.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19008.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 34215.08, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 19008.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19008.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Arthrd Wrist Complete Wo Grf", "code_information": [ { "code": "25800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20102.5, "discounted_cash": 7197, "minimum": 3858.1954, "maximum": 20102.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3858.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6915.45 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3858.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4244.02, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10076.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4244.02, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3858.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4244.02, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7629.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3858.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11156.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3858.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7084.71, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3858.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3858.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7197.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7557.68, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20777, "minimum": 17404.3, "maximum": 63547.704, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 63547.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27010.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 18448.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 26976.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33243.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27420.94 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20777.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29759.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20777.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 18274.52, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5803.82, "maximum": 10446.88, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10446.88, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5803.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5803.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5803.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6384.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6384.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5803.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6384.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5803.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5803.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14985.5, "discounted_cash": 3245, "minimum": 1739.7495, "maximum": 14985.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4746.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6711, "minimum": 5680.24, "maximum": 13870.095, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13870.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8724.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9000, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6021.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8804.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10738.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8384.2 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7478.61 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6711.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5964.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6458, "minimum": 5469.11, "maximum": 12909.588, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12909.59 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8395.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5797.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8477.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10333.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8041.37 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6458.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5901.79 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6458.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5469.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5742.57, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 2", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4256.71, "maximum": 7662.08, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4256.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4682.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4682.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4256.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4682.38, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4256.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4256.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7662.08, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4256.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4256.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4778.76, "maximum": 8601.77, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4778.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5256.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5256.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4778.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5256.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4778.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4778.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8601.77, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4778.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4778.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 1", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19790.9, "maximum": 35623.62, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19790.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 21769.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 21769.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19790.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21769.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19790.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19790.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 35623.62, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 19790.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19790.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bacitracin Intramuscular For Soln 50000 Unit", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "39822027805", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4532.42, "maximum": 8158.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4532.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4985.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4985.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4532.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4985.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4532.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4532.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8158.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4532.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4532.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13701, "minimum": 9000, "maximum": 30455.784, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 30455.78 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17811.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12197, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 17835.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21922.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17844.64 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13701.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19777.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13701.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11506.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12081.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 2", "code_information": [ { "code": "0082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23836.23, "maximum": 42905.21, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23836.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 26219.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 26219.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23836.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 26219.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23836.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23836.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 42905.21, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 23836.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23836.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3103.31, "maximum": 5585.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3103.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3413.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3413.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3103.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3413.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3103.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3103.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5585.96, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3103.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3103.31, "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": 22220, "minimum": 18607.8, "maximum": 40857.771, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 40857.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28887.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 19724.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 28842.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35553.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29375.14 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22220.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22578.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22220.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18607.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 19538.19, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35104.86, "maximum": 63188.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35104.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 38615.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 38615.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 35104.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 38615.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 35104.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35104.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 63188.75, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 35104.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35104.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9600.09, "maximum": 17280.16, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9600.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10560.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10560.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9600.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10560.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9600.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9600.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17280.16, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9600.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9600.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Azithromycin For Susp 100 Mg/5Ml", "drug_information": { "unit": 15, "type": "ML" }, "code_information": [ { "code": "42806014731", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 221.5, "10th_percentile": 221.5, "90th_percentile": 221.5, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 20.13, "count": "1 through 10" } ] } ] }, { "description": "Biopsy Vaginal Mucosa Simple", "code_information": [ { "code": "57100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5848, "discounted_cash": 913, "minimum": 489.7285, "maximum": 5848, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 948.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1279.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 968.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1416.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 899.28, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 959.31, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48460, "minimum": 40479.3, "maximum": 106389.588, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 106389.59 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 62998.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 42908.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 62742.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 77537.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 64888.82 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48460.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75894 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 48460.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40479.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 42503.27, "additional_payer_notes": "105.00% 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": 61219, "minimum": 17092.5, "maximum": 107343.084, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 107343.08 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 79584.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 54180.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 79226.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 97950.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 82156.52 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 61219.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17092.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 61219.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51113.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 53669.6, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Azithromycin Tab 500 Mg", "drug_information": { "unit": 3, "type": "EA" }, "code_information": [ { "code": "00781809003", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 221.5, "10th_percentile": 221.5, "90th_percentile": 221.5, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 20.13, "count": "1 through 10" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 1", "code_information": [ { "code": "7531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2945.61, "maximum": 5302.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2945.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3240.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3240.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2945.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3240.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2945.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2945.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5302.1, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2945.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2945.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Av Fuse Uppr Arm Cephalic", "code_information": [ { "code": "36818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12844.7, "discounted_cash": 5519, "minimum": 2568.24, "maximum": 12844.7, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3971.65 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7727.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5850.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8555.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5432.96, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5795.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19638.1, "maximum": 35348.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19638.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 21601.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 21601.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19638.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21601.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19638.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19638.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 35348.58, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 19638.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19638.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Aztreonam For Inj 2 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "63323040220", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 3", "code_information": [ { "code": "7533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6654.33, "maximum": 11977.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6654.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7319.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7319.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6654.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7319.76, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6654.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6654.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11977.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6654.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6654.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Azithromycin Tab 250 Mg", "drug_information": { "unit": 6, "type": "EA" }, "code_information": [ { "code": "64679096105", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 221.5, "10th_percentile": 221.5, "90th_percentile": 221.5, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 20.13, "count": "1 through 10" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6257.9, "maximum": 11264.22, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6257.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6883.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6883.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6257.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6883.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6257.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6257.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11264.22, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6257.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6257.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 1", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9343.96, "maximum": 16819.13, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9343.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10278.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10278.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9343.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10278.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9343.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9343.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16819.13, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9343.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9343.96, "additional_payer_notes": "100% of State Medicaid 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": 7623.38, "maximum": 13722.08, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8385.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8385.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8385.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13722.08, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7623.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7623.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18169, "minimum": 14400, "maximum": 38410.932, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 38410.93 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23620.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16145.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 23608.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29071.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23892.39 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18169.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25244 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18169.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15992.76, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13875, "minimum": 11651.5, "maximum": 29625.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 26882.51 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18037.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12350.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18059.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22200.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18079.95 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13875.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29625.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13875.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12234.08, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17727.18, "maximum": 31908.92, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17727.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 19499.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 19499.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17727.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19499.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17727.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17727.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 31908.92, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 17727.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17727.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33501, "minimum": 24300, "maximum": 55508.424, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 55508.42 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43551.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 29690.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 43415.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 53601.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44642.05 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33501.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37328.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 33501.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28010.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 29410.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23280, "minimum": 19490.6, "maximum": 57899.175, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23280, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28853 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23280, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 20465.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 57899.18 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30264, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 20660.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 30210.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37248, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30808.54 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 3", "code_information": [ { "code": "1383", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6897.41, "maximum": 12415.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6897.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7587.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7587.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6897.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7587.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6897.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6897.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12415.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6897.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6897.41, "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": 13867.29, "maximum": 24961.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13867.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15254.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15254.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13867.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15254.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13867.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13867.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24961.12, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13867.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13867.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 4", "code_information": [ { "code": "1384", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8994.3, "maximum": 16189.74, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8994.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9893.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9893.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8994.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9893.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8994.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8994.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16189.74, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8994.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8994.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18000, "maximum": 22088.1, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22088.1 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9088, "minimum": 7661.34, "maximum": 14541.216, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 11589.18 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11814.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 45000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8121.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11875.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14541.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11600.98 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9088.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8286.29 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9088.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7661.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8044.41, "additional_payer_notes": "105.00% 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": 31985, "minimum": 26747, "maximum": 90030.588, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 90030.59 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41581.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 28351.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 41457.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 51177.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42591.09 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31985.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66068.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31985.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26747, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 28084.35, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 1", "code_information": [ { "code": "1411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3334.43, "maximum": 6001.97, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3667.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3667.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3667.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6001.97, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3334.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3334.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38500 - OR36038500", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 3883, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3889.53 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5437.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4116.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6020.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3822.89, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4078.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 4", "code_information": [ { "code": "1414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11030.29, "maximum": 19854.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12133.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12133.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12133.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19854.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11030.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49261, "minimum": 31950, "maximum": 103638.939, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 103638.94 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 64039.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 43615.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 63777.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 78817.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 65972.24 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49261.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77161.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 49261.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41146.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 43203.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 2", "code_information": [ { "code": "7532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3606.87, "maximum": 6492.37, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3606.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3606.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3606.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3606.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6492.37, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3606.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3606.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11077, "minimum": 9319.49, "maximum": 28090.74, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 28090.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14400.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9878.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14445.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17724.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14293.39 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11077.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14627.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11077.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9319.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9785.46, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14529, "minimum": 12196.6, "maximum": 35667.294, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 35667.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18888.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18904.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23246.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18965.08 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14529.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23481.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14529.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12196.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12806.43, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 4", "code_information": [ { "code": "7534", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12285.92, "maximum": 22114.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12285.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13514.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13514.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12285.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13514.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12285.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12285.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22114.66, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12285.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12285.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Biopsy Of Cervix", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 913, "minimum": 489.7285, "maximum": 9137.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 948.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1279.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 968.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1416.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 899.28, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 913.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 959.31, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7842, "minimum": 6300.53, "maximum": 14000.967, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 14000.97 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10195.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7020.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10266.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12548.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9915.54 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7842.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6300.53 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7842.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6954.51, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 4", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 57719.32, "maximum": 103894.78, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 57719.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 63491.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 63491.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 57719.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 63491.25, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 57719.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 57719.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 103894.78, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 57719.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 57719.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11957, "minimum": 10052.9, "maximum": 22061.28, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 22061.28 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15544.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10656.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15582, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19132, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15484.3 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11957.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16421.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11957.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.55, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 2", "code_information": [ { "code": "8422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19194.9, "maximum": 34550.82, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19194.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 21114.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 21114.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19194.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21114.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19194.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19194.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 34550.82, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 19194.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19194.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52850, "minimum": 44138.4, "maximum": 207946.26, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 207946.26 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 68705.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 46786.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 68414.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 84560.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70830.27 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52850.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56898.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 52850.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44138.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 46345.32, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 2", "code_information": [ { "code": "1322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4702.63, "maximum": 8464.73, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4702.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5172.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5172.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4702.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5172.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4702.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4702.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8464.73, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4702.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4702.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 1", "code_information": [ { "code": "1321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3504.64, "maximum": 6308.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3504.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3504.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3504.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3504.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6308.35, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3504.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3504.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Azithromycin For Susp 200 Mg/5Ml", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "59762314001", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 221.5, "10th_percentile": 221.5, "90th_percentile": 221.5, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 20.13, "count": "1 through 10" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 2", "code_information": [ { "code": "3632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11745.93, "maximum": 21142.67, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12920.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12920.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12920.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21142.67, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11745.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11745.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 4", "code_information": [ { "code": "1964", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13694.36, "maximum": 24649.85, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13694.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15063.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15063.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13694.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15063.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13694.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13694.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24649.85, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13694.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13694.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 4", "code_information": [ { "code": "1324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9403.24, "maximum": 16925.83, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10343.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10343.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10343.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16925.83, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9403.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6429, "minimum": 5355.79, "maximum": 10287.936, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 6356.64 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8358.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5772.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8440.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10287.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8003.15 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6429.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5355.79 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6429.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5445.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5717.85, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6112, "minimum": 5180.74, "maximum": 11072.706, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 11072.71 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7945.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5491.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8030.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9779.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7573.13 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6112.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8857.21 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6112.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5180.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5439.78, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19409, "minimum": 15300, "maximum": 59724.372, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 59724.37 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25232.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 17240.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 25210.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31055.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25570.66 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19409.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36224.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19409.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 17078.04, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 1 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "63323040120", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4533, "minimum": 3864.66, "maximum": 10168.287, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 10168.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 5893.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 4096.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 5990.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7253.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5436.17 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4533.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5554.03 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 4533.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 3864.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 4057.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17542, "minimum": 9900, "maximum": 52110.426, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 52110.43 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22805.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 22797.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28067.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23043.1 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17542.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34264.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17542.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15443.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14708.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 2", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9818.16, "maximum": 17672.69, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9818.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10799.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10799.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9818.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10799.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9818.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9818.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17672.69, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9818.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9818.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 2", "code_information": [ { "code": "2012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4354.05, "maximum": 7837.29, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4354.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4789.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4789.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4354.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4789.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4354.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4354.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7837.29, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4354.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4354.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 3", "code_information": [ { "code": "3633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16817.95, "maximum": 30272.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18499.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18499.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18499.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30272.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16817.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31577, "minimum": 26407.1, "maximum": 68329.206, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 68329.21 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41051.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 27991.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 40931.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 50524.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42039.23 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31577.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37379.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31577.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26407.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 27727.46, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 3", "code_information": [ { "code": "2013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6035.48, "maximum": 10863.86, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6035.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6639.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6639.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6035.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6639.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6035.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6035.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10863.86, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6035.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6035.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCH EBUS SAMPLNG 12 NODE", "code_information": [ { "code": "31652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4483.05, "discounted_cash": 3698, "minimum": 896.37, "maximum": 4483.05, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3272.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2180.63, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4483.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2180.63, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2180.63, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3920.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4483.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3640.22, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.24, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23280, "minimum": 19490.6, "maximum": 40659.126, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 40659.13 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30264, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 20660.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 30210.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37248, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30808.54 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23280, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22063.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23280, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19490.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 20465.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "63323046357", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7009, "minimum": 5928.89, "maximum": 12991.383, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12991.38 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9112.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6284.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9189.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11215.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8787.94 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7009.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6013.94 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7009.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6225.33, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BRONCH EBUS SAMPLNG 3> NODE", "code_information": [ { "code": "31653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4195.39, "discounted_cash": 3698, "minimum": 838.85, "maximum": 4195.39, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3687.49 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2180.63, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4195.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2180.63, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2180.63, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3920.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4195.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3640.22, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1982.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3698.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.24, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18832, "minimum": 13907.2, "maximum": 30132.368, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20042.11 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24482.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16730.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 24464.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30132.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24789.46 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18832.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13907.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18832.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15783.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16572.78, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409904501", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11142, "minimum": 9373.93, "maximum": 19787.379, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19787.38 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14485.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9936.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14529.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17828.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14381.78 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11142.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10864.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11142.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9373.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 1", "code_information": [ { "code": "1381", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3247.42, "maximum": 5845.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3247.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3572.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3572.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3247.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3572.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3247.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3247.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5845.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3247.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3247.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 1", "code_information": [ { "code": "1911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5398.15, "maximum": 9716.67, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5398.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5937.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5937.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5398.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5937.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5398.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5398.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9716.67, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5398.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5398.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 2", "code_information": [ { "code": "1382", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4254.54, "maximum": 7658.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4679.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4679.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4679.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7658.17, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4254.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4254.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10844, "minimum": 9125.28, "maximum": 21252.678, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 21252.68 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14097.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9672.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14144.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17351.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13978.04 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10844.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15875.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10844.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9125.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9581.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Calcium Chloride Inj 10%", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409163110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 1", "code_information": [ { "code": "1921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6615.17, "maximum": 11907.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6615.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7276.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7276.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6615.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7276.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6615.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6615.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11907.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6615.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6615.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6888, "minimum": 4413.31, "maximum": 12516.972, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12516.97 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8955.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6177.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9033.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11022.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8624.29 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6888.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4413.31 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6888.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6119.52, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Carbachol Intraocular Inj 0.01%", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "00065002315", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 4", "code_information": [ { "code": "1924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17126.28, "maximum": 30827.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17126.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18838.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18838.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17126.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18838.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17126.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17126.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30827.3, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 17126.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17126.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.25% - 55150016830", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "55150016830", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "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": 23993, "minimum": 9900, "maximum": 55828.593, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 55828.59 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 31191.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 21290.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 31131.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 38388.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31773.7 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23993.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26918.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23993.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20085, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 21089.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 2", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12596.97, "maximum": 22674.55, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12596.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13856.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13856.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12596.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13856.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12596.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12596.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22674.55, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12596.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12596.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19732, "minimum": 16534, "maximum": 55686.036, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 55686.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25652.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 25627.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31572.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26007.85 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19732.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30690.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19732.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16534, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 17360.7, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 4", "code_information": [ { "code": "1774", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21719.22, "maximum": 39094.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21719.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 23891.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 23891.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21719.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23891.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21719.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21719.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39094.6, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 21719.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21719.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 3", "code_information": [ { "code": "8423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24113.57, "maximum": 43404.43, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24113.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 26524.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 26524.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24113.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 26524.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 24113.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24113.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 43404.43, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 24113.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24113.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31006, "minimum": 25930.4, "maximum": 53849.154, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 53849.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40307.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 27486.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 40192.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49609.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41265.2 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31006.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50601.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31006.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25930.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 27226.92, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 2", "code_information": [ { "code": "1962", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4002.76, "maximum": 7204.97, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4002.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4403.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4403.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4002.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4403.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4002.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4002.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7204.97, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4002.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4002.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28247, "minimum": 21600, "maximum": 47929.533, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 47929.53 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36722.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 25049.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 36628.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 45196.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37532.38 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28247.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35275.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28247.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23631.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 24813.08, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16922, "minimum": 14191.7, "maximum": 27076.544, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16922.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18971.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16922.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14901.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 26391.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21999.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15043.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 21997.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27076.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22204.56 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14191.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 1", "code_information": [ { "code": "2011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3312.13, "maximum": 5961.83, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3643.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3643.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3643.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5961.83, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17201, "minimum": 13500, "maximum": 42785.796, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 42785.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22362.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15289.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 22357.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27522.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22582.02 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17201.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31424.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17201.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15145.41, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8223.75, "discounted_cash": 3883, "minimum": 1644.3, "maximum": 8223.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4883.58 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5437.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4116.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6020.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3822.89, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4078.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5512, "minimum": 4681.23, "maximum": 9988.338, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9988.34 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7166.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 4962.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7255.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8820.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6762.06 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5512.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5108.84 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5512.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4681.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 4915.29, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 1", "code_information": [ { "code": "2001", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4207.23, "maximum": 7573.01, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4207.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4627.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4627.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4207.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4627.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4207.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4207.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7573.01, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4207.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4207.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Carboprost Tromethamine Im Soln 250 Mcg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00009085608", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "BIOPSYREMOVAL LYMPH NODES", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5891.66, "discounted_cash": 3883, "minimum": 1178.01, "maximum": 5891.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3922.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5437.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4116.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5891.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3822.89, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4078.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41278, "minimum": 14850, "maximum": 105737.565, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 105737.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53661.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 36562.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 53463.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 66045.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 55167.98 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41278.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60689.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 41278.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34492.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 36217.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 2", "code_information": [ { "code": "2052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4659.67, "maximum": 8387.41, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4659.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5125.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5125.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4659.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5125.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4659.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4659.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8387.41, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4659.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4659.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 1", "code_information": [ { "code": "1961", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2246.83, "maximum": 4044.29, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2246.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 2471.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 2471.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2246.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2471.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2246.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2246.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 4044.29, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2246.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2246.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Blepharoplasty Upper Eyelid", "code_information": [ { "code": "15822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10703.9, "discounted_cash": 2046, "minimum": 1097.0609, "maximum": 10703.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1685.86 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2169.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3172.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2014.5, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29225, "minimum": 24445.9, "maximum": 78156.291, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 78156.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37992.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 25912.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 37891.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 46760, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38854.7 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66928.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29225, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 25668.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17663, "minimum": 5400, "maximum": 29497.614, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 29497.61 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22962.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15697.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 22953.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28261.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23206.75 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17663.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25495.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17663.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14808.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15549.35, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 4", "code_information": [ { "code": "2014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10176.52, "maximum": 18317.74, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10176.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11194.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11194.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10176.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11194.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10176.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10176.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18317.74, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10176.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10176.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Blepharp Upr Eyelid Xcsv Skn", "code_information": [ { "code": "15823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10703.9, "discounted_cash": 2046, "minimum": 1097.0609, "maximum": 10703.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2065.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2169.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3172.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2014.5, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14901, "minimum": 9000, "maximum": 38754.471, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 38754.47 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19372.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13257.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19386.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23842.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19469.16 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14901.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19085.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14901.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12507.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13132.46, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 2", "code_information": [ { "code": "1912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6642.36, "maximum": 11956.25, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6642.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7306.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7306.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6642.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7306.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6642.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6642.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11956.25, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6642.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6642.36, "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": 58548, "minimum": 23400, "maximum": 128499.945, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 128499.95 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 76112.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 51821.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 75776.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 93677.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78541.96 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58548.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59494.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 58548.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 51332.19, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 3", "code_information": [ { "code": "1913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8984.51, "maximum": 16172.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8984.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9882.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9882.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8984.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9882.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8984.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8984.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16172.12, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8984.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8984.51, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 1", "code_information": [ { "code": "3631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8324.34, "maximum": 14983.81, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8324.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9156.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9156.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8324.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9156.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8324.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8324.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14983.81, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8324.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8324.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 86856, "minimum": 48150, "maximum": 191776.557, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 191776.56 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 112913.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 76832.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 112349.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 138971.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 116855.55 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 86856.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 130014 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 86856.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 72483.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 76107.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 3", "code_information": [ { "code": "1923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10389.15, "maximum": 18700.47, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10389.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11428.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11428.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10389.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11428.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10389.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10389.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18700.47, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10389.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10389.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 4", "code_information": [ { "code": "3634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17844.64, "maximum": 32120.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17844.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 19629.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 19629.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17844.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19629.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17844.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17844.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32120.35, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 17844.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17844.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 58548, "minimum": 10350, "maximum": 103349.151, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 103349.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 76112.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 51821.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 75776.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 93677.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 78541.96 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 58548.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 74805.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 58548.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48887.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 51332.19, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14424, "minimum": 12109.1, "maximum": 36202.467, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 36202.47 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18751.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12835.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18769.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23078.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18822.93 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14424.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18827.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14424.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12109.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12714.56, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47582, "minimum": 25200, "maximum": 103477.686, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 103477.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 61857.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 42132.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 61608.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 76131.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63700.3 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47582.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59374.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 47582.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39747.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 41734.77, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53529, "minimum": 27900, "maximum": 136085.847, "payers_information": [ { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 47386.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 69291.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 85646.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71748.84 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53529.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42677.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 53529.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 46939.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 136085.85 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 69588.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44704.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.25% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "63323046817", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30670.71, "maximum": 55207.28, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30670.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 33737.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 33737.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30670.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 33737.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 30670.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30670.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 55207.28, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 30670.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30670.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 2", "code_information": [ { "code": "3832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4364.93, "maximum": 7856.87, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4364.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4801.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4801.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4364.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4801.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4364.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4364.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7856.87, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4364.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4364.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21862.24, "maximum": 39352.03, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21862.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 24048.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 24048.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21862.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 24048.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21862.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21862.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39352.03, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 21862.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21862.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49036.47, "maximum": 88265.65, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 49036.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 53940.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 53940.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 49036.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 53940.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 49036.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 49036.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 88265.65, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 49036.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49036.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8203, "minimum": 6470.44, "maximum": 13950, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 11815.87 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10663.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13950, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000, "10th_percentile": 18000, "90th_percentile": 18000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7338.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10731.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13124.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10402.9 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8203.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6470.44 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8203.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6923.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7269.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45000, "minimum": 13950, "maximum": 88490.505, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 88490.51 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 58500.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 39850.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 58272.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 72000.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60205.19 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45000.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49427.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 45000.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 39474.65, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 1", "code_information": [ { "code": "8421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9994.35, "maximum": 17989.83, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9994.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10993.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10993.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9994.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10993.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9994.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9994.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17989.83, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9994.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9994.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 4", "code_information": [ { "code": "2054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12367.49, "maximum": 22261.48, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12367.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13604.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13604.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12367.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13604.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12367.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12367.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22261.48, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12367.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12367.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 3", "code_information": [ { "code": "5403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7042.06, "maximum": 12675.71, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7042.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7746.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7746.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7042.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7746.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7042.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7042.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12675.71, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7042.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7042.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1623", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37063.62, "maximum": 66714.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 37063.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 40769.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 40769.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 37063.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 40769.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 37063.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 37063.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 66714.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 37063.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37063.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 4", "code_information": [ { "code": "8424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 90267.38, "maximum": 162481.28, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 162481.28, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 90267.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 90267.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 90267.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 99294.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 99294.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 90267.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 99294.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 90267.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 90267.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Care Of Miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5848, "discounted_cash": 3211, "minimum": 1169.28, "maximum": 12490.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2804.59 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4495.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3403.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4977.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3160.61, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3371.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9872, "minimum": 7540, "maximum": 15587.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15587.79 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12834.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8814.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 12888.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12662.89 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10403.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9872.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8315.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8731.1, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50361.71, "maximum": 90651.08, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50361.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 55397.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 55397.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 50361.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 55397.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 50361.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50361.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 90651.08, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 50361.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 50361.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34678, "minimum": 21150, "maximum": 62395.563, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 62395.56 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 45081.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 30730.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 44936.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 55485.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46235.51 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34678.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48896.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 34678.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28991.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 30441.08, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 3", "code_information": [ { "code": "5393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7324.83, "maximum": 13184.69, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7324.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7324.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7324.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7324.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13184.69, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7324.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7324.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21700.73, "maximum": 39061.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21700.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 23870.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 23870.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21700.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23870.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21700.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21700.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39061.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 21700.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21700.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7915, "discounted_cash": 1937, "minimum": 1038.2804, "maximum": 7915, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1038.28, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2404.44 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1038.28, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1142.11, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2711.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1142.11, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1038.28, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1142.11, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2053.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1038.28, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3002.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1200, "10th_percentile": 1200, "90th_percentile": 1200, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1038.28, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1906.57, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1038.28, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1038.28, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1937, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2033.85, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10373, "minimum": 7540, "maximum": 15399, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 14842.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13485.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9256.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13535.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13340.18 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10373.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15399 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10373.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9169.07, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23505.6, "maximum": 42310.08, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23505.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 25856.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 25856.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23505.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25856.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23505.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23505.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 42310.08, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 23505.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23505.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15074, "minimum": 7540, "maximum": 20465.109, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20465.11 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19597.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13410.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19609.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19703.28 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15074.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15074.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13283.76, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 3", "code_information": [ { "code": "2053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6200.26, "maximum": 11160.47, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6200.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6820.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6820.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6200.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6820.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6200.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6200.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11160.47, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6200.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6200.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 3", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8342.28, "maximum": 15016.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8342.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9176.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9176.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8342.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9176.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8342.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8342.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15016.1, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8342.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8342.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33191.77, "maximum": 59745.19, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33191.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 36510.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 36510.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33191.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 36510.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 33191.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33191.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 59745.19, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 33191.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33191.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14301, "minimum": 9000, "maximum": 32804.469, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 32804.47 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18592.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12727.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18610.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22882.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18656.9 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14301.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26115.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14301.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12006.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12607.14, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42918, "minimum": 35859.5, "maximum": 94594.749, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 94594.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 55793.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 38011.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 55582.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 68668.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 57387.36 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42918.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57634.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42918.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35859.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 37652.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 4", "code_information": [ { "code": "1914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12143.99, "maximum": 21859.18, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12143.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13358.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13358.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12143.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13358.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12143.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12143.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21859.18, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12143.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12143.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12062, "minimum": 10140.5, "maximum": 21951.441, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 21951.44 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15681.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10748.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15717.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19300.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15626.45 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10236.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12062.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10140.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10647.53, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 1", "code_information": [ { "code": "3831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3461.68, "maximum": 6231.02, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3461.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3807.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3807.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3461.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3807.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3461.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3461.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6231.02, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3461.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3461.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 2", "code_information": [ { "code": "1922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8273.22, "maximum": 14891.8, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8273.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9100.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9100.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8273.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9100.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8273.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8273.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14891.8, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8273.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8273.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6871, "minimum": 5813.4, "maximum": 13760.256, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13760.26 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8932.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 18000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9010.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10993.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8600.4 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6871.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7424.24 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6871.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5813.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6104.07, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 3", "code_information": [ { "code": "3833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6333.49, "maximum": 11400.28, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6333.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6966.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6966.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6333.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6966.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6333.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6333.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11400.28, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6333.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6333.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8576, "minimum": 7234.67, "maximum": 19689.225, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19689.23 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11149.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7668.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11213.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13722.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10908.17 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8576.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10039.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8576.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7234.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7596.4, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13060, "minimum": 10972.5, "maximum": 24776.874, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 24776.87 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16978.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 20700, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11630.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 17007.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20897.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16977.43 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14377.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13060.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10972.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11521.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 2", "code_information": [ { "code": "2032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4911.99, "maximum": 8841.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4911.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5403.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5403.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4911.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5403.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4911.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4911.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8841.58, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4911.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4911.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 4", "code_information": [ { "code": "3834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9408.68, "maximum": 16935.62, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9408.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10349.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10349.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9408.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10349.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9408.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9408.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16935.62, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9408.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9408.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 63447, "minimum": 37350, "maximum": 140673.378, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 140673.38 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 82481.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 56149.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 82105.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 101516.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 85172.63 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63447.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 73766.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 63447.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 52971.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 55619.97, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26518, "minimum": 11250, "maximum": 45604.218, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 45604.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 34473.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 23521.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 34394.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 42429.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35191.16 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26518.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31235.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 26518.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22189.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 23299.19, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 3", "code_information": [ { "code": "2033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5465.58, "maximum": 9838.04, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5465.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6012.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6012.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5465.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6012.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5465.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5465.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9838.04, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5465.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5465.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43133, "minimum": 31950, "maximum": 69013.504, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 56073.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 38201.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 55860.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 69013.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 57678.82 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43133.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49901.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 43133.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 37840.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 60399.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 36039, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 1", "code_information": [ { "code": "1771", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8685.96, "maximum": 15634.73, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8685.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8685.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.56, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8685.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8685.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15634.73, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8685.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8685.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 2", "code_information": [ { "code": "5402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5958.26, "maximum": 10724.87, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5958.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6554.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6554.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5958.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6554.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5958.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5958.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10724.87, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5958.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5958.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 381635, "minimum": 55350, "maximum": 610616.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 158263.98 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 496126.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 337281.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 493194.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 610616.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 515818.55 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 381635.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 411453 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 381635.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 318190, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 334099.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 1", "code_information": [ { "code": "5401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4696.1, "maximum": 8452.98, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4696.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5165.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5165.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4696.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5165.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4696.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4696.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8452.98, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4696.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4696.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 3", "code_information": [ { "code": "1773", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18076.3, "maximum": 32537.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18076.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 19883.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 19883.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18076.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19883.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18076.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18076.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32537.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 18076.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18076.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 2", "code_information": [ { "code": "5392", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3975.03, "maximum": 7155.05, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3975.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4372.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4372.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3975.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4372.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3975.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3975.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7155.05, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3975.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3975.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 4", "code_information": [ { "code": "5404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16606.41, "maximum": 29891.54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16606.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18267.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18267.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16606.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18267.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16606.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16606.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29891.54, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16606.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16606.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18363, "minimum": 10800, "maximum": 30846.063, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 30846.06 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23872.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16315.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 23858.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29381.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24153.98 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22100.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15392.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16161.92, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8978, "minimum": 7540, "maximum": 13568.622, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13568.62 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11672.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11733.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11452.87 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8978.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11254.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8978.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7948.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22184, "minimum": 7540, "maximum": 29326.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 22624.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28840.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 19692.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 28795.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29326.17 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22184.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16488.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22184.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18577.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 19506.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 2", "code_information": [ { "code": "2002", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5604.79, "maximum": 10088.62, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5604.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6165.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6165.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5604.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6165.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5604.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5604.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10088.62, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5604.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5604.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18939, "minimum": 15872.7, "maximum": 42220.242, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 42220.24 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24621.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16825.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 24602.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30303.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24933.99 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18939.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17613.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18939.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16666.34, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 2", "code_information": [ { "code": "2632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9259.67, "maximum": 16667.41, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9259.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10185.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10185.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9259.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10185.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9259.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9259.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16667.41, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9259.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9259.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8970, "minimum": 7540, "maximum": 13325.574, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13325.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11661, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8016.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11722.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11440.92 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8970, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8631.79 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8970, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7562.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7940.91, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 3", "code_information": [ { "code": "2003", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11814.99, "maximum": 21266.98, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11814.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12996.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12996.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11814.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12996.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11814.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11814.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21266.98, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11814.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11814.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13260, "minimum": 11138.8, "maximum": 21216.272, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20986.26 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17238.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11807.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 17265.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21216.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17247.39 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13260.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11650.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13260.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11138.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11695.74, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 1", "code_information": [ { "code": "4701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3456.24, "maximum": 6221.23, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3456.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3801.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3801.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3456.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3801.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3456.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3456.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6221.23, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3456.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3456.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6605.39, "maximum": 11889.7, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6605.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7265.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7265.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6605.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7265.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6605.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6605.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11889.7, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6605.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6605.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 68283, "minimum": 38250, "maximum": 139275.852, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 139275.85 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 88768.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 60422.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 88353.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 109253.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 91717.29 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 68283.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 86169.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 68283.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 57002, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 59852.1, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23397, "minimum": 17664.6, "maximum": 41299.464, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 41299.46 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30416.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 20763.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 30362.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37435.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30967.41 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23397.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17664.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 23397.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19588.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 20567.82, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7499.39, "maximum": 13498.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8249.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8249.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8249.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13498.9, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7499.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15330.11, "maximum": 27594.2, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15330.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16863.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16863.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15330.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16863.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15330.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15330.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27594.2, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15330.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15330.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25582.37, "maximum": 46048.27, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25582.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 28140.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 28140.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25582.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 28140.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25582.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25582.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 46048.27, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 25582.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25582.37, "additional_payer_notes": "100% of State Medicaid 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": 31959, "minimum": 26724.9, "maximum": 63101.337, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 63101.34 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 41546.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 28328.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 41423.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 51134.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42555.26 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31959.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44056.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 31959.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 26724.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 28061.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 4", "code_information": [ { "code": "4704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13814.54, "maximum": 24866.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13814.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15195.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15195.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13814.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15195.99, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13814.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13814.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24866.17, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13814.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13814.54, "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": 8013, "minimum": 6765.32, "maximum": 12821.264, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12556.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10417.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7171.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10486.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12821.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10146.08 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8013.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8255.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8013.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6765.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31235.18, "maximum": 56223.32, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31235.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 34358.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 34358.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31235.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 34358.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 31235.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31235.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 56223.32, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 31235.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31235.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19072, "minimum": 15983.7, "maximum": 31301.778, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 31301.78 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24794.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16942.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 24774.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30516.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25114.36 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19072.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26802.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19072.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16782.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5832.65, "maximum": 10498.77, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6415.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6415.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6415.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10498.77, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5832.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 4", "code_information": [ { "code": "2034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8752.85, "maximum": 15755.13, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8752.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9628.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9628.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8752.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9628.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8752.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8752.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15755.13, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8752.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8752.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 1", "code_information": [ { "code": "2051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3709.11, "maximum": 6676.4, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3709.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3709.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3709.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4080.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4080.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3709.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4080.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3709.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3709.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6676.4, "additional_payer_notes": "180% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15171, "minimum": 12600, "maximum": 28338.462, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 28338.46 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19723.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13496.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19734.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24274.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19834.67 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20904.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12732.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13368.81, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9115.57, "maximum": 16408.03, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9115.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10027.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10027.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9115.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10027.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9115.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9115.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16408.03, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9115.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9115.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21614, "minimum": 8550, "maximum": 39941.667, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 39941.67 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28098.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 19188.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 28058.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34583.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28554.52 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21614.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31141.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21614.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18102.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 19007.52, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 3", "code_information": [ { "code": "2633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12409.36, "maximum": 22336.85, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12409.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13650.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13650.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12409.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13650.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12409.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12409.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22336.85, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12409.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12409.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7956, "minimum": 6718.24, "maximum": 15482.625, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15482.63 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10343.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 12150, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10413.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12730.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10069.64 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7956.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9100.76 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7956.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7054.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29670, "minimum": 24817.4, "maximum": 47473.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 46985.39 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38571.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 26306.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 38466.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 47473.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39457.92 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29670.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34407.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29670.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24817.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 26058.27, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3849.41, "maximum": 6928.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3849.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4234.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4234.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3849.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4234.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3849.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3849.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6928.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3849.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3849.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 1", "code_information": [ { "code": "2631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7292.75, "maximum": 13126.95, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7292.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8022.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8022.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7292.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8022.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7292.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7292.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13126.95, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7292.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7292.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4513.39, "maximum": 8124.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4513.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4964.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4964.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4513.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4964.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4513.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4513.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8124.1, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4513.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4513.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9838, "minimum": 8286.64, "maximum": 15741.504, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15057.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12789.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8783.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 12844.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15741.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12616.31 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11433.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9838.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8286.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8700.97, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9961, "minimum": 8388.9, "maximum": 21477.03, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 21477.03 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12949.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8892.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13002.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15937.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12782.34 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9961.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13730.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9961.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8388.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8808.35, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6182, "minimum": 5239.59, "maximum": 11360.157, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 11360.16 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8037.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5553.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8121.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9892.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7668.69 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6182.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5671.83 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6182.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5239.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5501.57, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 2", "code_information": [ { "code": "0952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10690.96, "maximum": 19243.73, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10690.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11760.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11760.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10690.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11760.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10690.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10690.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19243.73, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10690.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10690.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "63323041710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 1", "code_information": [ { "code": "0951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8057.33, "maximum": 14503.19, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8863.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8863.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8863.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14503.19, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8057.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8057.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Circum 28 Days Or Older", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9000, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 9000, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3582.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 4", "code_information": [ { "code": "0954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21780.13, "maximum": 39204.23, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21780.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 23958.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 23958.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21780.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23958.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21780.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21780.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39204.23, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 21780.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21780.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22062, "minimum": 7200, "maximum": 37289.172, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 37289.17 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28681.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 19584.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 28637.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35300.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29161.33 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22062.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26688.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22062.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18476.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 19399.91, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17887, "minimum": 14995.8, "maximum": 34435.695, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 34435.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23253.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15895.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 23243.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28619.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23510.15 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17887.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22440.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17887.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14995.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15745.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13978, "minimum": 11737.6, "maximum": 29836.479, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 29836.48 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18172.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12441.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18193.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22365.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18219.71 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13978.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14172.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13978.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11737.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12324.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 1", "code_information": [ { "code": "6611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4575.38, "maximum": 8235.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4575.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5032.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5032.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4575.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5032.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4575.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4575.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8235.68, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4575.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4575.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 1", "code_information": [ { "code": "5391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3133.77, "maximum": 5640.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3133.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3447.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3447.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3133.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3447.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3133.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3133.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5640.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3133.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3133.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6805, "minimum": 5758.22, "maximum": 10888.08, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 10105.19 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8846.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6103.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8925.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10888.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8510.81 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6805.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7530.73 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6805.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5758.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6046.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7744", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12000.43, "maximum": 21600.77, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12000.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13200.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13200.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12000.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13200.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12000.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12000.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21600.77, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12000.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12000.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 3", "code_information": [ { "code": "6613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15732.53, "maximum": 28318.55, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15732.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15732.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15732.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15732.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28318.55, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15732.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15732.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 4", "code_information": [ { "code": "5394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15282.8, "maximum": 27509.04, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15282.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16811.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16811.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15282.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16811.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15282.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15282.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27509.04, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15282.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15282.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Colonoscopy Thru Stoma Spx", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 922, "minimum": 494.467, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 944.09 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 543.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1291.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 543.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 543.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 977.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 907.98, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 968.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Chemodenervation anal musc", "code_information": [ { "code": "46505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5000, "discounted_cash": 1187, "minimum": 636.267, "maximum": 5000, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2513.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17834, "minimum": 14951.6, "maximum": 37303.194, "payers_information": [ { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 23174.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28535.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23438.48 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17834.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16957.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17834.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15699.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 37303.19 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23184.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15848.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14951.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy W/Control Bleed", "code_information": [ { "code": "45382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1187, "minimum": 636.267, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1035.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5220.33, "maximum": 9396.59, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5220.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5742.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5742.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5220.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5742.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5220.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5220.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9396.59, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5220.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5220.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7582, "minimum": 6406.33, "maximum": 13996.293, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13996.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9857.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6790.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9929.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12132.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9563.17 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7582.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6716.26 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7582.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6406.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6726.65, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy W/Lesion Removal", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7526.16, "discounted_cash": 1187, "minimum": 636.267, "maximum": 7526.16, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1035.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1200, "10th_percentile": 1200, "90th_percentile": 3600, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 1", "code_information": [ { "code": "2031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4414.42, "maximum": 7945.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4414.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4855.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4855.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4414.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4855.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4414.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4414.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7945.96, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4414.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4414.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 2", "code_information": [ { "code": "6612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7365.62, "maximum": 13258.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7365.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8102.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8102.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7365.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8102.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7365.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7365.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13258.12, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7365.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7365.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 3", "code_information": [ { "code": "3463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8577.2, "maximum": 15438.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8577.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9434.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9434.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8577.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9434.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8577.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8577.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15438.96, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8577.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8577.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Colonoscopy wballoon dilat", "code_information": [ { "code": "45386", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2436.66, "discounted_cash": 1187, "minimum": 487.2, "maximum": 2436.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1035.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 4", "code_information": [ { "code": "6614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25517.12, "maximum": 45930.82, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25517.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 28068.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 28068.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25517.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 28068.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25517.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25517.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 45930.82, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 25517.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25517.12, "additional_payer_notes": "100% of State Medicaid 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": 8161.2, "maximum": 14690.16, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8161.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8977.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8977.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8161.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8977.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8161.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8161.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14690.16, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8161.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8161.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Colonoscopy With Biopsy", "code_information": [ { "code": "44389", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1187, "minimum": 636.267, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1036.23 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7741", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3177.27, "maximum": 5719.09, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3177.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3495, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3495, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3177.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3495, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3177.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3177.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5719.09, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3177.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3177.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1653", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30428.72, "maximum": 54771.7, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30428.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 33471.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 33471.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30428.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 33471.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 30428.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30428.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 54771.7, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 30428.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30428.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10079, "minimum": 8487.48, "maximum": 17139.558, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17139.56 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13103.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8996.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13155.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16127.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12942.41 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10079.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11373.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10079.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8487.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8911.85, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18756, "minimum": 15720.4, "maximum": 36352.035, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 36352.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24383.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16663.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 24366.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30010.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24686.73 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18756.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25433.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18756.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15720.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16506.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7743", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5052.29, "maximum": 9094.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5557.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5557.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5557.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9094.12, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5052.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.29, "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": 34353.87, "maximum": 61836.97, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34353.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 37789.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 37789.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 34353.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 37789.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 34353.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34353.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 61836.97, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 34353.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34353.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16674, "minimum": 13985, "maximum": 33531.276, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 33531.28 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21677.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 14824.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 21676.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26679.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21868.91 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16674.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16152.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16674.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13985, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14684.25, "additional_payer_notes": "105.00% 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": 12548, "minimum": 10545.8, "maximum": 28172.535, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 28172.54 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16313.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11178.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 16345.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20078.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16284.62 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12548.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25736.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12548.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10545.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11073.09, "additional_payer_notes": "105.00% 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": 67991, "minimum": 50850, "maximum": 113335.152, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 113335.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 88388.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 60164.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 87975.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 108785.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 91321.91 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 67991.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 88894.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 67991.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 56758.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 59596.43, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 96488, "minimum": 56250, "maximum": 222026.685, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 222026.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 125434.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 85342.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 124793.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 154381.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 129891.12 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 96488.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 136978 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 96488.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 80511.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 84537.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 4", "code_information": [ { "code": "2634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20260.75, "maximum": 36469.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20260.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 22286.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 22286.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20260.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22286.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 20260.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20260.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 36469.35, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 20260.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20260.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Colonoscopy submucous njx", "code_information": [ { "code": "45381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2683.17, "discounted_cash": 1187, "minimum": 536.49, "maximum": 2683.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1035.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54023, "minimum": 34200, "maximum": 128135.373, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 128135.37 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 70230.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 47823.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 69929.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 86437.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 72417.76 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54023.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 76810.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 54023.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45116.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 47371.91, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10212, "minimum": 8598.56, "maximum": 21631.272, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 21631.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13276.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9114.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13327.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16340.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13122.78 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10212.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17231.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10212.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8598.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9028.49, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 2", "code_information": [ { "code": "4702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4215.93, "maximum": 7588.67, "payers_information": [ { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4637.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4637.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4637.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7588.67, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4215.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4215.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Colonoscopy W/Ablation", "code_information": [ { "code": "45388", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1187, "minimum": 636.267, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1036.23 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52311, "minimum": 36450, "maximum": 96440.979, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 96440.98 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 68004.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 46310.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 67717.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 83698.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70100.43 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52311.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68503.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 52311.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43689, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 45873.45, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Conization Of Cervix - 57520 - OR36057520", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 3211, "minimum": 277.4, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Barbara", "plan_name": "Barbara", "methodology": "fee schedule", "standard_charge_dollar": 277.4 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3580.31 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4495.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3403.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4977.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3160.61, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3371.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10292, "minimum": 8665.5, "maximum": 17398.965, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17398.97 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13380.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9185.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13431.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16468.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13231.48 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10292.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10229 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10292.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8665.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9098.78, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6592, "minimum": 5580.93, "maximum": 14029.011, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 14029.01 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8570.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5915.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8650.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10547.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8222.94 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6592.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6809.15 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6592.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5580.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5859.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34234.23, "maximum": 61621.61, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34234.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 37657.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 37657.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 34234.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 37657.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 34234.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34234.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 61621.61, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 34234.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34234.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 1", "code_information": [ { "code": "3461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5343.77, "maximum": 9618.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5878.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5878.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5878.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9618.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5343.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5343.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20046, "minimum": 16795.2, "maximum": 34765.212, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 34765.21 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26060.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 17802.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 26032.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32074.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26431.9 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20046.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23090.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20046.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16795.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 17634.96, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12447, "minimum": 10461.2, "maximum": 38908.713, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 38908.71 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16181.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11088.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 16214.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19915.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16147.25 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12447.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17738.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12447.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10984.26, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38709, "minimum": 20700, "maximum": 97350.072, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 97350.07 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 50321.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 34292.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 50144.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 61934.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51690.79 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38709.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59912.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 38709.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32351.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 33968.76, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 4", "code_information": [ { "code": "3464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15597.12, "maximum": 28074.82, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15597.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17156.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17156.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15597.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17156.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15597.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15597.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28074.82, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15597.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15597.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 3", "code_information": [ { "code": "0953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12597.52, "maximum": 22675.54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13857.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13857.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13857.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22675.54, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12597.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12597.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Conization Of Cervix - 57522 - OR36057522", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7422.67, "discounted_cash": 3211, "minimum": 234.66, "maximum": 7422.67, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Barbara", "plan_name": "Barbara", "methodology": "fee schedule", "standard_charge_dollar": 234.66 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2775.93 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4495.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1893.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3403.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4977.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3160.61, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1721.21, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3211.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3371.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Control Throat Bleeding", "code_information": [ { "code": "42960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11774.3, "discounted_cash": 534, "minimum": 286.768, "maximum": 11774.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.77, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 616.11 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.77, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 315.45, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 748.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 315.45, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.77, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 315.45, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 567.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.77, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 829.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.77, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.58, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 286.77, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.77, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 534.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 561.74, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7742", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3936.96, "maximum": 7086.53, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3936.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4330.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4330.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3936.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4330.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3936.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3936.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7086.53, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3936.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3936.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10696, "minimum": 9001.69, "maximum": 24008.001, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 24008 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13905.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9541.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13952.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17114.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13777.36 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10696.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14236.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10696.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9451.77, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 3", "code_information": [ { "code": "9103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27729.84, "maximum": 49913.71, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27729.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 30502.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 30502.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27729.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 30502.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 27729.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27729.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 49913.71, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 27729.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27729.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 1", "code_information": [ { "code": "3841", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4224.09, "maximum": 7603.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4224.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4646.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4646.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4224.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4646.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4224.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4224.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7603.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4224.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4224.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Colonoscopy And Biopsy", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7416.58, "discounted_cash": 1187, "minimum": 636.267, "maximum": 7416.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1035.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1661.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 699.89, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1258.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1839.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 3600, "10th_percentile": 2400, "90th_percentile": 3600, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1168.36, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 636.27, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1187.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1246.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22419, "minimum": 18773.3, "maximum": 49074.663, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 49074.66 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29145.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 19899.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 29098.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35871.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29643.91 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22419.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27457.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22419.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18773.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 19711.97, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 4", "code_information": [ { "code": "3844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14425.77, "maximum": 25966.39, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14425.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15868.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15868.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14425.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15868.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14425.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14425.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 25966.39, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14425.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14425.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Colonoscopy W/Resection", "code_information": [ { "code": "45390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 2753, "minimum": 1475.843, "maximum": 9137.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2023.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3854.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2918.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4267.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2710.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7896, "minimum": 6668.22, "maximum": 19513.95, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19513.95 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10265.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7068.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10335.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12634.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9988.41 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7896.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9154 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7896.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6668.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7001.63, "additional_payer_notes": "105.00% 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": 22198.31, "maximum": 39956.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22198.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 24418.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 24418.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22198.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 24418.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22198.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22198.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39956.96, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 22198.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22198.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48728, "minimum": 36450, "maximum": 93566.469, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 93566.47 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 63347.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 43145.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 63089.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 77966.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 65251.95 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48728.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 72911.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 48728.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40703, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 42738.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14992.41, "maximum": 26986.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14992.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16491.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16491.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14992.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16491.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14992.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14992.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26986.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14992.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14992.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1652", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25440.44, "maximum": 45792.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25440.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 27984.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 27984.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25440.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 27984.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25440.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25440.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 45792.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 25440.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25440.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21582.18, "maximum": 38847.92, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21582.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 23740.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 23740.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21582.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23740.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21582.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21582.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 38847.92, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 21582.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21582.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10770.5, "discounted_cash": 3496, "minimum": 1874.2597, "maximum": 10770.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4311.61 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15292.59, "maximum": 27526.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15292.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16821.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16821.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15292.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16821.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15292.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15292.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27526.66, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15292.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15292.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9362, "minimum": 7890.13, "maximum": 18957.744, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 18957.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12171.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8363.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 12229.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14980.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11972.47 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9362.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9355.64 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9362.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8284.64, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22739.93, "maximum": 40931.87, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22739.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 25013.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 25013.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22739.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25013.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22739.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22739.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 40931.87, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 22739.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22739.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 733, "minimum": 392.9706, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 392.97, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 901.38 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 392.97, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 432.27, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1026.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 432.27, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 392.97, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 432.27, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 392.97, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1136.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 392.97, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721.6, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 392.97, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 392.97, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 733.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 769.78, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51090, "minimum": 32850, "maximum": 105284.187, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 105284.19 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 66417.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 45231.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 66140.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 81745.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68448.43 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51090.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71699.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 51090.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42671.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 44805.18, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7782, "minimum": 6572.58, "maximum": 20194.017, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20194.02 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10116.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6966.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10187.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12451.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9833.12 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7782.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14116.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7782.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6901.21, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28326, "minimum": 10350, "maximum": 64188.042, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 64188.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36824.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 25118.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 36730.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 45322.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37638.7 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28326.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45161.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28326.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23697, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 24881.85, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35042, "minimum": 17550, "maximum": 81783.315, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 81783.32 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 45554.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 31052.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 45406.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 56067.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46727.65 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35042.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44158.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 35042.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29294.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 30759.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 2", "code_information": [ { "code": "3462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6310.65, "maximum": 11359.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6941.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6941.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6941.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11359.17, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6310.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28850, "minimum": 12150, "maximum": 46161.264, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 38030 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37506.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 25582.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 37407.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 46161.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38348.23 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28850.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35987.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28850.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24134, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 25340.7, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 3", "code_information": [ { "code": "0423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9124.81, "maximum": 16424.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9124.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10037.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10037.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9124.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10037.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9124.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9124.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16424.66, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9124.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9124.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 1", "code_information": [ { "code": "0451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4983.77, "maximum": 8970.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4983.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5482.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5482.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4983.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5482.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4983.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4983.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8970.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4983.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4983.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 2", "code_information": [ { "code": "3842", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5214.35, "maximum": 9385.83, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5214.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5735.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5735.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5214.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5735.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5214.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5214.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9385.83, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5214.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5214.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14675, "minimum": 12318.7, "maximum": 26583.375, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 26583.38 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19078.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13057.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19093.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23481.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19163.36 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14675.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17046.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14675.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12934.64, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6769, "minimum": 5728.8, "maximum": 12844.152, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12844.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8800.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6072.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8879.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10831.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8463.03 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6769.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6601.84 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6769.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5728.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6015.24, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 4", "code_information": [ { "code": "0454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13829.77, "maximum": 24893.59, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13829.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15212.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15212.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13829.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15212.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13829.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13829.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24893.59, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13829.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13829.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cor hlx vlgs prx mtar osteot", "code_information": [ { "code": "28295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6422.36, "discounted_cash": 3245, "minimum": 1284.12, "maximum": 6422.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3590.83 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9614, "minimum": 8099.79, "maximum": 19247.532, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19247.53 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12498.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 12600, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8585.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 12554.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15382.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12312.91 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9614.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10614.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9614.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8504.78, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 3", "code_information": [ { "code": "1143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6281.82, "maximum": 11307.28, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6910, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6910, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6910, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11307.28, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6281.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6281.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 74916, "minimum": 48600, "maximum": 143024.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 143024.4 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 97391.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 66282.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 96923.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 119866.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 100695.16 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 74916.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67109.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 74916.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 62531.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 65657.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40644, "minimum": 29250, "maximum": 90420.867, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 90420.87 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 52837.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 36002.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 52644.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 65031.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54310.33 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40644.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48396.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 40644.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 35662.62, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8820, "minimum": 5197.2, "maximum": 18000, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9763.99 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11467.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7884.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11529.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14113.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11239.05 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8820.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5197.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8820.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7438.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7810.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37485, "minimum": 26100, "maximum": 76719.036, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 76719.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48731.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 33211.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 48563.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 59977.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50035.22 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37485.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55365.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 37485.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31331.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 32898.08, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 2", "code_information": [ { "code": "9102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19129.64, "maximum": 34433.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19129.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 21042.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 21042.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19129.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21042.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19129.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19129.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 34433.35, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 19129.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19129.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "63323016501", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 45, "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "1 through 10" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12452.32, "maximum": 22414.18, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12452.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13697.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13697.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12452.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13697.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12452.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12452.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22414.18, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12452.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12452.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18044.76, "maximum": 32480.57, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18044.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 19849.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 19849.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18044.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19849.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18044.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18044.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32480.57, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 18044.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18044.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 2", "code_information": [ { "code": "0452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6485.21, "maximum": 11673.38, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6485.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7133.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7133.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6485.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7133.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6485.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6485.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11673.38, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6485.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6485.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52224 - OR36052224", "code_information": [ { "code": "52224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7936.58, "discounted_cash": 3496, "minimum": 1586.88, "maximum": 7936.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3353.73 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27957, "minimum": 13500, "maximum": 67364.025, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 67364.03 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36344.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 24792.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 36253.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 44732.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37139.39 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27957.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32173.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 27957.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 24558.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl Iv Soln 200 Mcg/2Ml - 16729023930", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "16729023930", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy And Treatment - 52276 - OR36052276", "code_information": [ { "code": "52276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10965, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 10965, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2956.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22783, "minimum": 7200, "maximum": 60892.872, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29618.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 20220.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 29568.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 36452.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30136.04 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22783.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32120 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22783.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 20030.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 60892.87 } ] } ] }, { "description": "Cysto W/Urtrl Cathj", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3259.92 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7551.43, "discounted_cash": 3496, "minimum": 1509.87, "maximum": 7551.43, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3358.87 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59923, "minimum": 39600, "maximum": 176511.273, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 176511.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 77900.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 53035.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 77552.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 95877.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 80402.99 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59923.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 113390 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 59923.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 50033.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 52535.6, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52240 - OR36052240", "code_information": [ { "code": "52240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16704, "discounted_cash": 5318, "minimum": 2850.9133, "maximum": 16704, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5034.09 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7446.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5637.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8243.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5235.06, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5584.55, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy W/Biopsy(S)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8563.15, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 9274.4, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2969.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32606.1, "maximum": 58690.98, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32606.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 35866.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 35866.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 32606.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 35866.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 32606.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32606.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 58690.98, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 32606.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32606.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 9703.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1654.26 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 10%", "drug_information": { "unit": 500, "type": "ML" }, "code_information": [ { "code": "00338002303", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "CYSTOURETERO STRICTURE TX", "code_information": [ { "code": "52344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7500, "discounted_cash": 3496, "minimum": 1499.59, "maximum": 7500, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2211.61 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 3", "code_information": [ { "code": "0453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9562.57, "maximum": 17212.63, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9562.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9562.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10518.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9562.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9562.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17212.63, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9562.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9562.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTOURETERO & OR PYELOSCOPE", "code_information": [ { "code": "52351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12000, "discounted_cash": 3496, "minimum": 1874.2597, "maximum": 12000, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3472.24 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 1", "code_information": [ { "code": "4201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3236.54, "maximum": 5825.77, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3560.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3560.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3560.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5825.77, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3236.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18601, "minimum": 15590.9, "maximum": 30095.886, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 30095.89 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24181.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 16526.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 24165.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29762.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24476.5 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17268.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 18601.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15590.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16370.45, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Stone Remove", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8249.86, "discounted_cash": 3496, "minimum": 1649.52, "maximum": 8249.86, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3288.14 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dantrolene Sodium For Iv Soln 20 Mg", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00143929701", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7936.58, "discounted_cash": 691, "minimum": 370.7524, "maximum": 7936.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.99 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 968.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1072.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 680.8, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 726.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9931.09, "maximum": 10800, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9931.09 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10555, "minimum": 4927.6, "maximum": 24019.686, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 24019.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13722.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16889.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13587.44 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4927.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10555.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9328.97, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 1", "code_information": [ { "code": "2401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5360.08, "maximum": 9648.14, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5360.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5896.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5896.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5360.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5896.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5360.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5360.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9648.14, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5360.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5360.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 2", "code_information": [ { "code": "1792", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18586.93, "maximum": 33456.47, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18586.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 20445.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 20445.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18586.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 20445.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18586.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18586.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 33456.47, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 18586.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18586.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7766.4, "maximum": 13979.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13979.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7766.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11192, "minimum": 9415.13, "maximum": 18635.5508, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 18635.55 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14550, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9980.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14593.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17907.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14448.67 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11192.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12999.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11192.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9415.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9885.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 2", "code_information": [ { "code": "0422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6426.48, "maximum": 11567.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6426.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6426.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6426.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6426.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11567.66, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6426.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6426.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15838.57, "maximum": 28509.43, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15838.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17422.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17422.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15838.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17422.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15838.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15838.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28509.43, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15838.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15838.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 2", "code_information": [ { "code": "5172", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6713.06, "maximum": 12083.51, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6713.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7384.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7384.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6713.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7384.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6713.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6713.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12083.51, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6713.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6713.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11951, "minimum": 10047.8, "maximum": 31320.474, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 31320.47 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15536.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10650.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15574.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19122.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15475.94 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11951.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18303.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11951.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10047.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10550.19, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9097.43, "discounted_cash": 5318, "minimum": 1818.99, "maximum": 9097.43, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4618.49 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7446.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5637.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8243.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 7200, "10th_percentile": 7200, "90th_percentile": 7200, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5235.06, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5584.55, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 1", "code_information": [ { "code": "2821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3475.27, "maximum": 6255.49, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3475.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3822.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3822.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3475.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3822.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3475.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3475.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6255.49, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3475.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3475.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Delay Flap F/C/C/N/Ax/G/H/F", "code_information": [ { "code": "15620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10234, "discounted_cash": 2046, "minimum": 1097.0609, "maximum": 10234, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1864.43 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2169.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3172.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2014.5, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9678.68, "discounted_cash": 3496, "minimum": 1874.2597, "maximum": 9678.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3679.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14904, "minimum": 12509.3, "maximum": 30324.912, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 30324.91 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19375.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13259.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19389.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23847.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19472.74 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14904.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18493.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14904.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12509.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13134.77, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52260 - OR36052260", "code_information": [ { "code": "52260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8155, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 8155, "payers_information": [ { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3232.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 403, "minimum": 216.1414, "maximum": 9137.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.42 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 564.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 427.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 396.89, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 4", "code_information": [ { "code": "7524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16006.6, "maximum": 28811.88, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16006.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17607.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17607.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16006.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17607.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16006.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16006.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28811.88, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16006.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16006.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 2", "code_information": [ { "code": "1142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3584.58, "maximum": 6452.24, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3584.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3943.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3943.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3584.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3943.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3584.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3584.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6452.24, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3584.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3584.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52281 - OR36052281", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7807.23, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 7807.23, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2582.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 3", "code_information": [ { "code": "1793", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22893.83, "maximum": 41208.89, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22893.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 25183.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 25183.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22893.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25183.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22893.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22893.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 41208.89, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 22893.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22893.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10175, "minimum": 8567.66, "maximum": 18420.234, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 18420.23 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13228.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500, "10th_percentile": 4500, "90th_percentile": 4500, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9081.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16280.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13072.61 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10175.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9951.47 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10175.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8567.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8996.04, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy Chemodenervation", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7792.86, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 7792.86, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3427.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 1", "code_information": [ { "code": "0421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6006.12, "maximum": 10811.02, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6006.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6606.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6606.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6006.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6606.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6006.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6006.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10811.02, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6006.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6006.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Destruction anal lesion(s)", "code_information": [ { "code": "46924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2753, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3478.2 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3854.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2918.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4267.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2710.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10710.1, "discounted_cash": 5318, "minimum": 2141.44, "maximum": 10710.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4632.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7446.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3136.01, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5637.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8243.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5235.06, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2850.91, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5318.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5584.55, "additional_payer_notes": "105.00% 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": 9463.6, "maximum": 17034.48, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9463.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10409.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10409.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9463.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10409.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9463.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9463.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17034.48, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9463.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9463.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15300, "maximum": 15440.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15440.9 } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 1", "code_information": [ { "code": "1141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3503.55, "maximum": 6306.39, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3503.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3853.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3853.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3503.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3853.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3503.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3503.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6306.39, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3503.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3503.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 1", "code_information": [ { "code": "3041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13319.14, "maximum": 23974.45, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13319.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14651.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14651.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13319.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14651.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13319.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13319.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23974.45, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13319.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13319.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "55150030401", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 45, "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "1 through 10" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 3", "code_information": [ { "code": "3033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36423.03, "maximum": 65561.45, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36423.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 40065.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 40065.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 36423.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 40065.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 36423.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36423.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 65561.45, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 36423.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36423.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 1", "code_information": [ { "code": "1791", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15743.4, "maximum": 28338.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15743.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17317.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17317.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15743.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17317.74, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15743.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15743.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28338.12, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15743.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15743.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 10 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00641036725", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 45, "median_amount": 1.2, "10th_percentile": 1.2, "90th_percentile": 1.2, "count": "1 through 10" } ] } ] }, { "description": "Drain Lower Leg Lesion", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9280, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 9280, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl Iv Soln 200 Mcg/2Ml - 00409163802", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "00409163802", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 4", "code_information": [ { "code": "1794", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29934.95, "maximum": 53882.91, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 29934.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 32928.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 32928.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29934.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 32928.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 29934.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 29934.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 53882.91, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 29934.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29934.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 2", "code_information": [ { "code": "7702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2605.19, "maximum": 4689.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2605.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 2865.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 2865.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2605.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2865.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2605.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2605.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 4689.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2605.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2605.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21019, "minimum": 17606.6, "maximum": 42524.052, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 42524.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27325.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 18663, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 27290.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33631.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27749.43 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21019.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27408.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 21019.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17606.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 18486.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11738, "minimum": 9870.49, "maximum": 22921.296, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 22921.3 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15260.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10462.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15299.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18781.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15188.07 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11738.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13778 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11738.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10364.01, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 2", "code_information": [ { "code": "4202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4400.28, "maximum": 7920.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4400.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4840.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4840.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4400.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4840.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4400.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4400.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7920.5, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4400.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4400.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7551, "minimum": 6380.58, "maximum": 19051.224, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19051.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9817.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6763.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9889.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12082.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9521.36 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10068.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6699.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 3", "code_information": [ { "code": "4203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6161.65, "maximum": 11090.97, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6161.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6777.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6777.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6161.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6777.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6161.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6161.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11090.97, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6161.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6161.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8546, "minimum": 7209.66, "maximum": 17955.171, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17955.17 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11110.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7642.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11174.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13674.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10867.56 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8546.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9296.73 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8546.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7209.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7570.14, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 4", "code_information": [ { "code": "4204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9287.41, "maximum": 16717.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9287.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10216.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10216.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9287.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10216.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9287.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9287.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16717.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9287.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9287.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 1", "code_information": [ { "code": "1101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5009.33, "maximum": 9016.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5009.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5510.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5510.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5009.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5510.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5009.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5009.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9016.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5009.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5009.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8426, "minimum": 7109.61, "maximum": 13500, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12201.48 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10954.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7536.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11019.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13482.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10705.11 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8426.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7173.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8426.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7465.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.61, "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": 15668, "minimum": 13146.3, "maximum": 48062.742, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 48062.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20369.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13935.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 20376.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25069.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20507.18 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15668.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18309.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15668.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13146.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13803.62, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 4", "code_information": [ { "code": "1104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13585.6, "maximum": 24454.08, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13585.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14944.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14944.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13585.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14944.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13585.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13585.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24454.08, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13585.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13585.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5999, "minimum": 5086.58, "maximum": 9883.173, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9883.17 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7799.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5391.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7884.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9598.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7420.23 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5999.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5194.93 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5999.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5086.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5340.91, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 4", "code_information": [ { "code": "1144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14786.86, "maximum": 26616.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14786.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16265.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16265.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14786.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16265.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14786.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14786.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26616.35, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14786.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14786.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 3", "code_information": [ { "code": "7593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10911.19, "maximum": 19640.14, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10911.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12002.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12002.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10911.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12002.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10911.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10911.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19640.14, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10911.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10911.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Diagnostic Colonoscopy", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7470.56, "discounted_cash": 922, "minimum": 494.467, "maximum": 7470.56, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 944.09 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 543.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1291.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 543.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 543.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 3122.1, "10th_percentile": 2615.1, "90th_percentile": 3407.1, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 977.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1200, "10th_percentile": 900, "90th_percentile": 3600, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 907.98, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 922.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 968.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl In Nacl 0.9% Iv Soln 400 Mcg/100Ml", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "9999-1217-32", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19392, "minimum": 16250, "maximum": 32453.919, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 32453.92 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25209.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 17225, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 25187.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 31027.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25546.77 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19392.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24613 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19392.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16250, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 17062.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Egd guide wire insertion", "code_information": [ { "code": "43248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2964.37, "discounted_cash": 899, "minimum": 482.251, "maximum": 2964.37, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 826.28 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 953.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1394.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 900, "10th_percentile": 900, "90th_percentile": 900, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 885.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 2", "code_information": [ { "code": "2402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6446.05, "maximum": 11602.89, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6446.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7090.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7090.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6446.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7090.66, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6446.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6446.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11602.89, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6446.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6446.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl-Dextrose Iv Soln 400 Mcg/100Ml-5%", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "44567060324", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8518.47, "maximum": 15333.25, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8518.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8518.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9370.32, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8518.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8518.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15333.25, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8518.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8518.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 3", "code_information": [ { "code": "2403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9089.46, "maximum": 16361.03, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9089.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9998.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9998.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9089.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9998.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9089.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9089.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16361.03, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9089.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9089.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dilate esophagus", "code_information": [ { "code": "43453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2436.66, "discounted_cash": 1903, "minimum": 487.2, "maximum": 2436.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1139.07 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2436.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2436.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22269, "maximum": 40084.2, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22269, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 24495.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 24495.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22269, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 24495.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22269, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22269, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 40084.2, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 22269, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22269, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8674, "minimum": 7316.32, "maximum": 14240.1121, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 14240.11 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11276.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7755.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11340.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13878.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11040.76 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8674.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10062.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8674.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7316.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7682.14, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 1", "code_information": [ { "code": "5171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5475.91, "maximum": 9856.64, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6023.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6023.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6023.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9856.64, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5475.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Enalaprilat Iv Soln 1.25 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "00143978710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "Diltiazem Hcl Iv Soln 50 Mg/10Ml (5 Mg/Ml)", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "17478093705", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "Endo cholangiopancreatograph - 43262 - ", "code_information": [ { "code": "43262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1827.5, "discounted_cash": 3824, "minimum": 365.4, "maximum": 1827.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 70%", "drug_information": { "unit": 1000, "type": "ML" }, "code_information": [ { "code": "00264129055", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9563, "minimum": 8057.12, "maximum": 17130.21, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17130.21 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12432, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8540.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15300.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12243.63 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9563.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9299 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9563.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8459.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 3", "code_information": [ { "code": "5173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10379.36, "maximum": 18682.85, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10379.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11417.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11417.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10379.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11417.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10379.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10379.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18682.85, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10379.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10379.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13196, "minimum": 11085.8, "maximum": 21114.608, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19336.34 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17155.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11750.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 17182.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21114.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17161.38 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13196.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12114 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13196.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11640.09, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 1", "code_information": [ { "code": "2841", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3855.39, "maximum": 6939.7, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4240.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4240.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4240.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6939.7, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3855.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 4", "code_information": [ { "code": "5174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14657.98, "maximum": 26384.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14657.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16123.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16123.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14657.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16123.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14657.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14657.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26384.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14657.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14657.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Diag laparo separate proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5887.17, "discounted_cash": 5996, "minimum": 1177.11, "maximum": 5887.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4980.65 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3535.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3535.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3535.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3214.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5887.17, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 2", "code_information": [ { "code": "2842", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5719.54, "maximum": 10295.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6291.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6291.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6291.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10295.17, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5719.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5719.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 4", "code_information": [ { "code": "2404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12421.87, "maximum": 22359.37, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12421.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13664.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13664.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12421.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13664.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12421.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12421.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22359.37, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12421.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12421.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 4", "code_information": [ { "code": "2824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13100.53, "maximum": 23580.95, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13100.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14410.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14410.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13100.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14410.58, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13100.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13100.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23580.95, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13100.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13100.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6001, "minimum": 5088.05, "maximum": 11437.278, "payers_information": [ { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6488.57 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6001.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5342.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 11437.28 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7801.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10350, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 9000, "90th_percentile": 9000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5393.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5088.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7886.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9601.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7422.62 } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 3", "code_information": [ { "code": "2843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7179.09, "maximum": 12922.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7179.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7897, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7897, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7179.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7897, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7179.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7179.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12922.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7179.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7179.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 2", "code_information": [ { "code": "7522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3421.98, "maximum": 6159.56, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3421.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3764.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3764.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3421.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3764.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3421.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3421.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6159.56, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3421.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3421.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12268, "minimum": 10311.9, "maximum": 29684.574, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 29684.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15948.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10930.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15983.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19629.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15904.77 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17379.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12268.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10311.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9036, "minimum": 7617.94, "maximum": 17548.533, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17548.53 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11747.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8075.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11807.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14457.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11530.51 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9036.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10564.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9036.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7617.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7998.84, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17870, "minimum": 13886.8, "maximum": 28593.152, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 18939.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23231.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15880.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 23221.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28593.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23487.45 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17870.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13886.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17870.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14981.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15730.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6994, "minimum": 5641.24, "maximum": 14872.668, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 14872.67 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9093.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6271.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9170.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11191.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8767.63 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5641.24 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5916.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.21, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16356, "minimum": 13719.4, "maximum": 46882.557, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 46882.56 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21263.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 14542.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 21265.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26169.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21437.69 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16356.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20486.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16356.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13719.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14405.37, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7818, "minimum": 6602.75, "maximum": 15573.768, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15573.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10163.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6998.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10234.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12509.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9882.1 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7587.36 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6602.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6932.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6692, "minimum": 5664.06, "maximum": 13944.879, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13944.88 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8699.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6003.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 8779.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10707.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8357.92 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6692.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6803.48 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6692.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5664.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5947.26, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 2", "code_information": [ { "code": "2442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4487.28, "maximum": 8077.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4487.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4936.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4936.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4487.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4936.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4487.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4487.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8077.1, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4487.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4487.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 4", "code_information": [ { "code": "2844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9344.51, "maximum": 16820.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9344.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10278.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10278.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9344.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10278.96, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9344.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9344.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16820.12, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9344.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9344.51, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 2", "code_information": [ { "code": "2822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4585.17, "maximum": 8253.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4585.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5043.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5043.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4585.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5043.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4585.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4585.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8253.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4585.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4585.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 4", "code_information": [ { "code": "2444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11665.45, "maximum": 20997.81, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11665.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12832, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12832, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11665.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12832, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11665.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11665.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20997.81, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11665.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11665.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11710, "minimum": 9846.95, "maximum": 20123.907, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20123.91 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15223.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10437.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15262.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18736.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15149.84 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11710.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11732.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11710.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9846.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10339.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 3", "code_information": [ { "code": "2823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6710.34, "maximum": 12078.61, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7381.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7381.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7381.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12078.61, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6710.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6710.34, "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": 7940, "minimum": 6705, "maximum": 15608.823, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15608.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10323.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7107.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10392.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12705.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10048.13 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7940.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8632.92 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7940.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6705, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7040.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 1", "code_information": [ { "code": "7521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2814.56, "maximum": 5066.21, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2814.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3096.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3096.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2814.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3096.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2814.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2814.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5066.21, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2814.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2814.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 3", "code_information": [ { "code": "7523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7455.89, "maximum": 13420.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7455.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8201.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8201.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7455.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8201.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7455.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7455.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13420.6, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7455.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7455.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31510.88, "maximum": 56719.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31510.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 34661.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 34661.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31510.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 34661.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 31510.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31510.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 56719.58, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 31510.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31510.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Abd Les Sc 3 Cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 9137.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3184.63 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15263, "minimum": 12808.7, "maximum": 31306.452, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 31306.45 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19842.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13577.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19853.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24421.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19958.9 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15263.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15169.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15263.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.14, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 1", "code_information": [ { "code": "3031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22815.52, "maximum": 41067.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22815.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 25097.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 25097.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22815.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25097.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22815.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22815.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 41067.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 22815.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22815.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Abdl Tum Deep 5 Cm/>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2881, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2253.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 1", "code_information": [ { "code": "2441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3474.19, "maximum": 6253.54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3821.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3821.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3821.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6253.54, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3474.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25349.63, "maximum": 45629.33, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25349.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 27884.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 27884.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25349.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 27884.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25349.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25349.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 45629.33, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 25349.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25349.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXC FOREARM LES SC < 3 CM", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4264.16, "discounted_cash": 1638, "minimum": 852.6, "maximum": 4264.16, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2420.42 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 3", "code_information": [ { "code": "2443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7104.05, "maximum": 12787.29, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7104.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7814.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7814.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7104.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7814.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7104.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7104.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12787.29, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7104.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7104.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56943.32, "maximum": 102497.98, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 56943.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 62637.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 62637.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 56943.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 62637.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 56943.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 56943.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 102497.98, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 56943.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 56943.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11250, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 11250, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2022.44 } ] } ] }, { "description": "Exc Hand Les Sc < 1.5 Cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1831.9 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 1", "code_information": [ { "code": "7701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2116.32, "maximum": 3809.38, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2116.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 2327.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 2327.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2116.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2327.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2116.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2116.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 3809.38, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2116.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2116.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Drain Bl W/Cath Insertion", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7727.72, "discounted_cash": 2073, "minimum": 1111.4746, "maximum": 10242.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1731.31 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2902.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1222.62, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2197.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3214, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2040.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1111.47, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2073.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2177.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hip/Pelv Tum Deep 5 Cm/>", "code_information": [ { "code": "27045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2881, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2253.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% 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": 16869.07, "maximum": 30364.33, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16869.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18555.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18555.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16869.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18555.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16869.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16869.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30364.33, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16869.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16869.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 4", "code_information": [ { "code": "7704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10606.67, "maximum": 19092.01, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10606.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11667.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11667.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10606.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11667.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10606.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10606.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19092.01, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10606.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10606.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Drainage Of Pelvis Lesion", "code_information": [ { "code": "26990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 3245, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2663.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Les Sc < 3 Cm", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 9137.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3043.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 3", "code_information": [ { "code": "3043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24524.14, "maximum": 44143.45, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24524.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 26976.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 26976.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24524.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 26976.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 24524.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24524.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 44143.45, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 24524.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24524.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 4", "code_information": [ { "code": "7594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21675.17, "maximum": 39015.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21675.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 23842.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 23842.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21675.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23842.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21675.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21675.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39015.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 21675.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21675.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Drainage Of Scrotum Abscess", "code_information": [ { "code": "55100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 976.43 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Tum Deep < 5 Cm", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7812.5, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 7812.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3190.16 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Egd Dilate Stricture", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1903, "minimum": 1020.3021, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2446.76 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Tum Deep 5 Cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2881, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4013.72 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Drain thighknee lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2401.87, "discounted_cash": 2881, "minimum": 480.24, "maximum": 2401.87, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2401.87, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Egd Remove Lesion Snare", "code_information": [ { "code": "43251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7732.5, "discounted_cash": 1903, "minimum": 1020.3021, "maximum": 7732.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1752.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Rect Tum Transanal Part", "code_information": [ { "code": "45171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12183.3, "discounted_cash": 2753, "minimum": 1475.843, "maximum": 12183.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3437.42 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3854.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2918.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4267.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2710.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 3", "code_information": [ { "code": "7703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3400.77, "maximum": 6121.39, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3400.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3740.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3740.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3400.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3740.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3400.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3400.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6121.39, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3400.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3400.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14688.43, "maximum": 26439.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14688.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16157.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16157.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14688.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16157.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14688.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14688.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26439.17, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 14688.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14688.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7150, "minimum": 6045.86, "maximum": 15118.053, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 15118.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9295.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6408.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9371.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11440.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8977.86 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8699.76 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7150.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6045.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6348.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc snhfg mal+mrg 1.1-2", "code_information": [ { "code": "11622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3198.12, "discounted_cash": 702, "minimum": 257.55, "maximum": 3198.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.55 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bronchoscope/Lavage", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6996.72, "discounted_cash": 1765, "minimum": 946.3897, "maximum": 6996.72, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2095.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1041.03, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2471.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1041.03, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1041.03, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1871.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1737.83, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1853.85, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8366.21, "maximum": 15059.18, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8366.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9202.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9202.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8366.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9202.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8366.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8366.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15059.18, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8366.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8366.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 2", "code_information": [ { "code": "1102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5502.02, "maximum": 9903.64, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5502.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6052.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6052.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5502.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6052.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5502.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5502.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9903.64, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5502.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5502.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 0.6-1 cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2250, "discounted_cash": 403, "minimum": 216.1414, "maximum": 2250, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 503.16 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 564.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 427.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 900, "10th_percentile": 900, "90th_percentile": 900, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 396.89, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bronchoscope/Wash", "code_information": [ { "code": "31622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8563.15, "discounted_cash": 1765, "minimum": 946.3897, "maximum": 8563.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3076.49 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1041.03, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2471.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1041.03, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1041.03, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1871.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2736.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1737.83, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 946.39, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1765.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1853.85, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15044, "minimum": 12626.2, "maximum": 25288.677, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19558.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13383.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19570.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24071.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19662.66 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15044.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16794.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15044.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13257.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 25288.68 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Egd Biopsy Single/Multiple", "code_information": [ { "code": "43239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7529.17, "discounted_cash": 899, "minimum": 482.251, "maximum": 7529.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1011.53 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 953.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1394.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 2400, "10th_percentile": 1800, "90th_percentile": 3600, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 885.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext Mal+Marg 0.6-1 Cm", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 702, "minimum": 235.27, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19204, "minimum": 16093.3, "maximum": 30726.864, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 30612.36 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24965.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 17058.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 24944.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30726.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25292.34 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19204.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16146.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 19204.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16093.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 16897.97, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42534, "minimum": 4584.36, "maximum": 96761.148, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 96761.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 55294.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 37671.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 55086.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 68054.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56867.76 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42534.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4584.36 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 42534.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 37316.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Egd control bleeding any", "code_information": [ { "code": "43255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3350.42, "discounted_cash": 1903, "minimum": 669.9, "maximum": 3350.42, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2184.91 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext Mal+Marg 3.1-4 Cm", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 702, "minimum": 376.5147, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1386.01 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 3", "code_information": [ { "code": "1103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10028.06, "maximum": 18050.51, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10028.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10028.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11030.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10028.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10028.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18050.51, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10028.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10028.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Egd Diagnostic Brush Wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7486.04, "discounted_cash": 899, "minimum": 482.251, "maximum": 7486.04, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 833.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 953.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1394.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 3600, "10th_percentile": 3600, "90th_percentile": 3600, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 885.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Explore wound chest", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9000, "discounted_cash": 2046, "minimum": 1097.0609, "maximum": 9000, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1603.52 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2169.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3172.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2014.5, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 1", "code_information": [ { "code": "7591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5791.32, "maximum": 10424.38, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5791.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6370.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6370.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5791.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6370.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5791.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5791.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10424.38, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5791.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5791.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Egd Place Gastrostomy Tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8249.86, "discounted_cash": 1903, "minimum": 1020.3021, "maximum": 8249.86, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1888.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 1", "code_information": [ { "code": "8411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31555.47, "maximum": 56799.85, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31555.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 34711.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 34711.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31555.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 34711.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 31555.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31555.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 56799.85, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 31555.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 31555.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 2", "code_information": [ { "code": "7592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7149.19, "maximum": 12868.54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7149.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7864.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7864.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7149.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7864.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7149.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7149.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12868.54, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7149.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7149.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Egd Remove Foreign Body", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7479, "discounted_cash": 899, "minimum": 482.251, "maximum": 7479, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1937.49 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 953.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1394.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 3600, "10th_percentile": 3600, "90th_percentile": 3600, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 885.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 4", "code_information": [ { "code": "8414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 140003.88, "maximum": 252006.98, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 140003.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 154004.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 154004.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 140003.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 154004.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 140003.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 140003.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 252006.98, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 140003.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 140003.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 187844, "minimum": 108450, "maximum": 439559.319, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 439559.32 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 244197.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 166058.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 242821.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 300550.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 253535.01 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 187844.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 292874 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 187844.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 156659, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 164491.95, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Egd Varices Ligation", "code_information": [ { "code": "43244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1903, "minimum": 1020.3021, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1904.08 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 2924, "10th_percentile": 2924, "90th_percentile": 2924, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 188950, "minimum": 108000, "maximum": 391022.166, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 391022.17 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 245635.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 167035.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 244250.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 302320.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 255031.72 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 188950.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 298287 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 188950.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 157581, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 165460.05, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Egd Endo Mucosal Resection", "code_information": [ { "code": "43254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1903, "minimum": 1020.3021, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3062.98 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep < 5 Cm", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8223.75, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 8223.75, "payers_information": [ { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 2", "code_information": [ { "code": "3262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9554.41, "maximum": 17197.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10509.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10509.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10509.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17197.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9554.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9554.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34885, "minimum": 11700, "maximum": 55817.296, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 44977.9 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 45351.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 30914.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 45204.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 55817.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46516.22 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34885.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54406.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 34885.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29164.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 30622.52, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 2", "code_information": [ { "code": "3242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10399.48, "maximum": 18719.06, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10399.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11439.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11439.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10399.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11439.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10399.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10399.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18719.06, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10399.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10399.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc 3 Cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2881, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2872.16 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12484.41, "maximum": 22471.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12484.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12484.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12484.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12484.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22471.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12484.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12484.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 1", "code_information": [ { "code": "9501", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8960.04, "maximum": 16128.07, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8960.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9856.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9856.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8960.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9856.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8960.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8960.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16128.07, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8960.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8960.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20446.18, "maximum": 36803.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20446.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 22490.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 22490.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20446.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22490.8, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 20446.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20446.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 36803.12, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 20446.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20446.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXC BACK LES SC 3 CM>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2961.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Endo cholangiopancreatograph - 43261 - ", "code_information": [ { "code": "43261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3655, "discounted_cash": 3824, "minimum": 730.8, "maximum": 3655, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2049.99, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2125.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2049.99, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2254.99, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2254.99, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2049.99, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2254.99, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2049.99, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2049.99, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2049.99, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2049.99, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3655, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 2", "code_information": [ { "code": "7922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11698.62, "maximum": 21057.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11698.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12868.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12868.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11698.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12868.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11698.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11698.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21057.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11698.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11698.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7297, "minimum": 5833.82, "maximum": 11700, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9864.48 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9486.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6538.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9561.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11676.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9177.34 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7297.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5833.82 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7297.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6168.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6477.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Tum Deep 2 Cm/>", "code_information": [ { "code": "21014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7932.44, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 7932.44, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3014.92 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 3", "code_information": [ { "code": "8433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17305.19, "maximum": 31149.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 19035.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 19035.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19035.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 31149.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 17305.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17305.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54604, "minimum": 11700, "maximum": 115298.232, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 115298.23 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 70985.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 48336.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 70680.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 87366.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 73203.74 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54604.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47582.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 54604.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45600.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 47880.21, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 1.1-2", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2436.66, "discounted_cash": 702, "minimum": 376.5147, "maximum": 2436.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 1", "code_information": [ { "code": "1781", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22444.1, "maximum": 40399.38, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22444.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 24688.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 24688.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22444.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 24688.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 22444.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22444.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 40399.38, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 22444.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22444.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Forearm Les Sc 3 Cm/>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1776.41 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 3", "code_information": [ { "code": "1783", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30267.76, "maximum": 54481.97, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30267.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 33294.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 33294.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30267.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 33294.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 30267.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30267.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 54481.97, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 30267.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30267.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg >4 cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4873.34, "discounted_cash": 2881, "minimum": 974.4, "maximum": 4873.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3079.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Ephedrine Sulfate Inj 50 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "42023021625", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 2", "code_information": [ { "code": "0092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36437.17, "maximum": 65586.91, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36437.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 40080.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 40080.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 36437.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 40080.89, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 36437.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36437.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 65586.91, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 36437.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 36437.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Leg/Ankle Les Sc 3 Cm/>", "code_information": [ { "code": "27632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8781.58, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 8781.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2253.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10891, "minimum": 5400, "maximum": 28242.645, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 28242.65 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14158.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 9714.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 14204.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17426.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14041.35 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10891.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18545.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 10891.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9164.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 9622.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Duct Stent Placement", "code_information": [ { "code": "43274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 6022, "minimum": 1827, "maximum": 9137.5, "payers_information": [ { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9137.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5927.41, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6323.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5530.55 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3550.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8430.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3550.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3550.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6383.34, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "Exc S/N/H/F/G Mal+Mrg 3.1-4", "code_information": [ { "code": "11624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1332.3 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 2", "code_information": [ { "code": "0922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12327.25, "maximum": 22189.05, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12327.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13559.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13559.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12327.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13559.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12327.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12327.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22189.05, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12327.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12327.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 9137.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3154.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Ercp ea ductampulla dilate", "code_information": [ { "code": "43277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1827.5, "discounted_cash": 3824, "minimum": 365.4, "maximum": 1827.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1827.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 3", "code_information": [ { "code": "5143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13930.92, "maximum": 25075.66, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13930.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15324.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15324.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13930.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15324.01, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13930.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13930.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 25075.66, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13930.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13930.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Esmolol Hcl-Sodium Chloride Iv Soln 2500 Mg/250Ml", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "67457065725", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "Exc snhfg mal+mrg 2.1-3", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3198.12, "discounted_cash": 1638, "minimum": 282.65, "maximum": 3198.12, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 282.65 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Remove Forgn Body Duct", "code_information": [ { "code": "43275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1903, "minimum": 1020.3021, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3797.87 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Esoph Egd Dilation <30 Mm", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1903, "minimum": 1020.3021, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1328.93 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2664.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1122.33, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2017.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2950.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1200, "10th_percentile": 1200, "90th_percentile": 1200, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1873.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1020.3, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1903.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1998.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc thighknee tum deep <5cm", "code_information": [ { "code": "27328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3045.83, "discounted_cash": 2881, "minimum": 609, "maximum": 3045.83, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3045.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3045.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3045.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Stent Exchange W/Dilate", "code_information": [ { "code": "43276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 6022, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5893.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3550.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7310, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3550.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3550.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6383.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7310, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5927.41, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3227.95, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6022.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6323.12, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 2", "code_information": [ { "code": "7222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3388.81, "maximum": 6099.86, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3388.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3727.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3727.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3388.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3727.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3388.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3388.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6099.86, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3388.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3388.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397, "minimum": 6251.84, "maximum": 12297.294, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12297.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9616.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000, "10th_percentile": 4500, "90th_percentile": 18000, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6626.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9690.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11835.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9312.32 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7397.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7305.31 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7397.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6251.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6564.43, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc thighknee tum dep 5cm>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9000, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 9000, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2253.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 3", "code_information": [ { "code": "7223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5113.74, "maximum": 9204.73, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5113.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5625.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5625.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5113.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5625.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5113.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5113.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 9204.73, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5113.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5113.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg >4.0 cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7693.72, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7693.72, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3009.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 100 Mg/10Ml", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "67457018210", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10035.4, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 10035.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3234.12 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 0.5 cm<", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4500, "discounted_cash": 702, "minimum": 376.5147, "maximum": 4500, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1800, "10th_percentile": 1800, "90th_percentile": 1800, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Etomidate Iv Soln 2 Mg/Ml", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "55150022110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "Exc Face Les Sbq 2 Cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7310, "payers_information": [ { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2022.44 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg 1.1-2 cm", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4873.34, "discounted_cash": 403, "minimum": 216.1414, "maximum": 4873.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 681.61 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 564.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 237.76, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 427.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 396.89, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.14, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 403.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep < 5 Cm", "code_information": [ { "code": "21932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9137.5, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 9137.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 3", "code_information": [ { "code": "3143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12176.62, "maximum": 21917.92, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12176.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13394.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13394.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12176.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13394.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12176.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12176.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21917.92, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12176.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12176.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Hip/Pelv Tum Deep < 5 Cm", "code_information": [ { "code": "27048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2881, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXCISION RADIAL HEAD", "code_information": [ { "code": "24130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22500, "discounted_cash": 3245, "minimum": 1739.7495, "maximum": 22500, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2663.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc face-mm b9+marg 1.1-2 cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4873.34, "discounted_cash": 702, "minimum": 376.5147, "maximum": 4873.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 4", "code_information": [ { "code": "3404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11965.08, "maximum": 21537.14, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11965.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13161.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13161.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11965.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13161.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11965.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11965.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21537.14, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11965.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11965.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc S/N/H/F/G Mal+Mrg >4 Cm", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2881, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 3", "code_information": [ { "code": "8413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50989.8, "maximum": 91781.64, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50989.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 56088.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 56088.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 50989.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 56088.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 50989.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50989.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 91781.64, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 50989.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 50989.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 702, "minimum": 376.5147, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% 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": 13091, "minimum": 10998.2, "maximum": 21409.257, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 21409.26 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17019.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 18450, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500, "10th_percentile": 13500, "90th_percentile": 13500, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11658.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 17047.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20946.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17019.24 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13091.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14740.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13091.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10998.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11548.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10094.5, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 10094.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3547.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39799.48, "maximum": 71639.06, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39799.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 43779.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 43779.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 39799.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 43779.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 39799.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39799.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 71639.06, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 39799.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39799.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10703.9, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 10703.9, "payers_information": [ { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2769.56 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 3", "code_information": [ { "code": "3423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7524.95, "maximum": 13544.91, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8277.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8277.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8277.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13544.91, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7524.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7524.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc skn hppu smplntrm", "code_information": [ { "code": "11470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 2881, "minimum": 1461.6, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 2", "code_information": [ { "code": "9502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12506.7, "maximum": 22512.06, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12506.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 13757.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 13757.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12506.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13757.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12506.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12506.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 22512.06, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 12506.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12506.7, "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": 5482.5, "discounted_cash": 2881, "minimum": 1096.2, "maximum": 5482.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3118.59 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7631, "minimum": 5881.39, "maximum": 13905.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13905.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9920.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6833.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9992.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12209.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9628.86 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7631.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5881.39 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7631.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6769.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Les Sc 3 Cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10965, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 10965, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2934.66 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 1", "code_information": [ { "code": "8431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4048.44, "maximum": 7287.19, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4048.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4453.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4453.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4048.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4453.28, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4048.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4048.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7287.19, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4048.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4048.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7919.17, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 7919.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3293.71 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37316, "minimum": 5012.865, "maximum": 59706.256, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 5012.87 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48511.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 33061.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 48344.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 59706.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 49805.87 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52439.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 37316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31190.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 32749.82, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 1.1-2 Cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 702, "minimum": 208.08, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 45, "median_amount": 377.12, "10th_percentile": 377.12, "90th_percentile": 377.12, "count": "1 through 10" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 2", "code_information": [ { "code": "1782", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24856.95, "maximum": 44742.51, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24856.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 27342.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 27342.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24856.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 27342.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 24856.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24856.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 44742.51, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 24856.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24856.95, "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": 16447.5, "discounted_cash": 2881, "minimum": 1544.4596, "maximum": 16447.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1931.8 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4033.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1698.91, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3054.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4466.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2836.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1544.46, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2881.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3025.39, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc/Crtg B1 Cst/B9 Tum Rds", "code_information": [ { "code": "24120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10965, "discounted_cash": 3245, "minimum": 1739.7495, "maximum": 10965, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2282.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 3", "code_information": [ { "code": "0093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 72877.2, "maximum": 131178.96, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 72877.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 80164.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 80164.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 72877.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 80164.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 72877.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 72877.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 131178.96, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 72877.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 72877.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc snhfg mal+mrg 0.6-1", "code_information": [ { "code": "11621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6396.26, "discounted_cash": 702, "minimum": 236.37, "maximum": 6396.26, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.37 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXCISE WRIST TENDON SHEATH", "code_information": [ { "code": "25118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5848, "discounted_cash": 1595, "minimum": 854.9813, "maximum": 5848, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2663.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 940.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2233.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 940.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 940.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2472.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1569.98, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1674.79, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 1", "code_information": [ { "code": "0821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3554.67, "maximum": 6398.41, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3554.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3910.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3910.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3554.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3910.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3554.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3554.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6398.41, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3554.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3554.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 2.1-3Cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 702, "minimum": 376.5147, "maximum": 7310, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 983.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 45, "median_amount": 188.56, "10th_percentile": 188.56, "90th_percentile": 188.56, "count": "1 through 10" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1088.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Excision Breast Lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15462.3, "discounted_cash": 3883, "minimum": 468.84, "maximum": 15462.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Barbara", "plan_name": "Barbara", "methodology": "fee schedule", "standard_charge_dollar": 468.84 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3262.91 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5437.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2290.06, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4116.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6020.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3822.89, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2081.87, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3883.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4078.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7310, "discounted_cash": 1638, "minimum": 878.1644, "maximum": 7310, "payers_information": [ { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1736.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2539.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1612.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1720.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2076.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.16, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1638.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 965.98, "additional_payer_notes": "58.96% of Medicare Rates" } ] } ] }, { "description": "Excision Olecranon Bursa", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16447.5, "discounted_cash": 3245, "minimum": 1739.7495, "maximum": 16447.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3542.14 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 1", "code_information": [ { "code": "5311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3312.13, "maximum": 5961.83, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3643.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3643.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3643.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5961.83, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3312.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Excision of anal lesion(s)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4281.57, "discounted_cash": 2753, "minimum": 856.08, "maximum": 4281.57, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2894.05 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3854.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2918.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4267.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2710.05, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1475.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2753.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXPLORE SCROTUM", "code_information": [ { "code": "55110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8563.15, "discounted_cash": 3496, "minimum": 1712.16, "maximum": 8563.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1916.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4895.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2061.69, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3706.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5419.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3441.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1874.26, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3496.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3671.42, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 2", "code_information": [ { "code": "5312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4351.88, "maximum": 7833.38, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4787.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4787.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4787.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7833.38, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4351.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4351.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 2", "code_information": [ { "code": "8412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33641.49, "maximum": 60554.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33641.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 37005.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 37005.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33641.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 37005.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 33641.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33641.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 60554.68, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 33641.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33641.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Goniotomy", "code_information": [ { "code": "65820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13500, "discounted_cash": 4100, "minimum": 2197.7775, "maximum": 13500, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2197.78, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2798.23 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2197.78, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2417.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5740.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2417.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2197.78, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2417.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4346.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2197.78, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6355.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2197.78, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4035.72, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2197.78, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2197.78, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4100.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4305.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11389.19, "maximum": 20500.54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11389.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12528.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12528.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11389.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12528.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11389.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11389.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20500.54, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11389.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11389.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 1", "code_information": [ { "code": "5301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4799.97, "maximum": 8639.95, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4799.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5279.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5279.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4799.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5279.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4799.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4799.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8639.95, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4799.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4799.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 2", "code_information": [ { "code": "9112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13638.35, "maximum": 24549.03, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13638.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15002.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15002.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13638.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15002.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13638.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13638.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24549.03, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13638.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13638.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 3", "code_information": [ { "code": "3163", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11669.25, "maximum": 21004.65, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12836.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12836.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12836.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21004.65, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11669.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11669.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 3", "code_information": [ { "code": "9113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19465.17, "maximum": 35037.31, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19465.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 21411.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 21411.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19465.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21411.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19465.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19465.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 35037.31, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 19465.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19465.17, "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": 12760, "minimum": 6300, "maximum": 34807.278, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 34807.28 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16588.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 11365.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 16619.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20417.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16571.3 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12760.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21843.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 12760.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10722.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11258.52, "additional_payer_notes": "105.00% 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": 28109.41, "maximum": 50596.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28109.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 30920.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 30920.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28109.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 30920.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 28109.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28109.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 50596.94, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 28109.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28109.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 4", "code_information": [ { "code": "3164", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16379.65, "maximum": 29483.37, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16379.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18017.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18017.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16379.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18017.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16379.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16379.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29483.37, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16379.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16379.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 3", "code_information": [ { "code": "9503", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17863.68, "maximum": 32154.62, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17863.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 19650.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 19650.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17863.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 19650.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17863.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17863.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32154.62, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 17863.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17863.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 1", "code_information": [ { "code": "5141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7857.76, "maximum": 14143.97, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7857.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8643.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8643.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7857.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8643.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7857.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7857.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14143.97, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7857.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7857.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15644, "minimum": 9000, "maximum": 32771.751, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 32771.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20337.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13913.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 20344.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25030.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20473.73 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15644, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14386.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 15644, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13125.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13781.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Car Outp Meas Drg Car Cath Eval Cgen Hrt Defect", "code_information": [ { "code": "93598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888, "minimum": 177.55, "maximum": 888, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 888 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22214, "minimum": 18450, "maximum": 43276.566, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 43276.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28879.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 19718.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 28834.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35543.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29366.78 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22214.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26926.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 22214.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18602.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 19532.73, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 4", "code_information": [ { "code": "5144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28816.9, "maximum": 51870.42, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28816.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 31698.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 31698.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28816.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 31698.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 28816.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28816.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 51870.42, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 28816.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28816.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 1", "code_information": [ { "code": "7921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9340.7, "maximum": 16813.26, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9340.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10274.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10274.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9340.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10274.77, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9340.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9340.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16813.26, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9340.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9340.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 3215, "minimum": 1723.7599, "maximum": 14807.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1723.76, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14807.6 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1723.76, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.14, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4502.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.14, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1723.76, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1896.14, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3408.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1723.76, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4984.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1723.76, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3165.3, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1723.76, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1723.76, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3215.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3376.61, "additional_payer_notes": "105.00% 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": 41925, "minimum": 35031.9, "maximum": 103776.822, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 103776.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 54502.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 37133.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 54299.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 67080.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 56043.55 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41925.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63410.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 41925.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35031.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 36783.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 1", "code_information": [ { "code": "7221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2866.76, "maximum": 5160.17, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2866.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2866.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3153.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 2866.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2866.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 5160.17, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 2866.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2866.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 4", "code_information": [ { "code": "7924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27922.89, "maximum": 50261.2, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27922.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 30715.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 30715.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27922.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 30715.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 27922.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27922.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 50261.2, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 27922.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27922.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "7923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16529.19, "maximum": 29752.54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16529.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18182.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18182.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16529.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18182.11, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16529.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16529.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29752.54, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16529.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16529.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 2", "code_information": [ { "code": "8432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6011.56, "maximum": 10820.81, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6011.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6612.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6612.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6011.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6612.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6011.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6011.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10820.81, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6011.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6011.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 4", "code_information": [ { "code": "8434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25760.2, "maximum": 46368.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25760.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 28336.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 28336.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25760.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 28336.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 25760.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25760.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 46368.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 25760.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25760.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6265.72, "discounted_cash": 1595, "minimum": 854.9813, "maximum": 6265.72, "payers_information": [ { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 940.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2233.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 940.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 940.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1690.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2472.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1569.98, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1674.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2149.33 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 854.98, "additional_payer_notes": "53.60% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14837, "minimum": 8550, "maximum": 29235.87, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 29235.87 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19288.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 13200.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 19302.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23739.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19381.96 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14837.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22697.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14837.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12453.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 13076.07, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 4", "code_information": [ { "code": "1784", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39204.02, "maximum": 70567.24, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39204.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 43124.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 43124.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 39204.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 43124.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 39204.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39204.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 70567.24, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 39204.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39204.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29571, "minimum": 22050, "maximum": 51621.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 44353.92 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38443.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 26219.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 38339.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 47314.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39324.13 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29571.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51621.9 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 29571.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24735, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 25971.75, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 1", "code_information": [ { "code": "0091", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33850.31, "maximum": 60930.56, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33850.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 37235.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 37235.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33850.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 37235.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 33850.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33850.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 60930.56, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 33850.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33850.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Flumazenil Iv Soln 0.5 Mg/5Ml (0.1 Mg/Ml)", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "63323042405", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 2", "code_information": [ { "code": "0822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5612.41, "maximum": 10102.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5612.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6173.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6173.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5612.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6173.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5612.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5612.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10102.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5612.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5612.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 4", "code_information": [ { "code": "0094", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 120929.55, "maximum": 217673.19, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 120929.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 133022.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 133022.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 120929.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 133022.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 120929.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 120929.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 217673.19, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 120929.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 120929.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 4", "code_information": [ { "code": "0924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34149.4, "maximum": 61468.92, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34149.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 37564.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 37564.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 34149.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 37564.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 34149.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34149.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 61468.92, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 34149.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34149.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14063, "minimum": 11808.2, "maximum": 26376.8, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17688.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18282.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12516.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18302.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22501.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18334.38 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14063.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26376.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14063.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12398.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 1", "code_information": [ { "code": "3141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6378.62, "maximum": 11481.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6378.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7016.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7016.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6378.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7016.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6378.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6378.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11481.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6378.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6378.62, "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": 6151.31, "maximum": 11072.36, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6766.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6766.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6766.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11072.36, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 6151.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6151.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52972, "minimum": 8320.28, "maximum": 84755.744, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 20056.13 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 68864.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 46894.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 68572, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 84755.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70995.11 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52972.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8320.28 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 52972.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44240, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 46452, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16339, "minimum": 13705.4, "maximum": 26143.136, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 26015.48 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21241.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 14527.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 21243.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26143.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21415 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16339.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16241.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16339.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13705.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14390.67, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 2", "code_information": [ { "code": "5142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11817.71, "maximum": 21271.88, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11817.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12999.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12999.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11817.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12999.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11817.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11817.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21271.88, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 11817.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11817.71, "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": 10038.94, "maximum": 18070.09, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10038.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11042.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11042.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10038.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11042.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10038.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10038.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18070.09, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10038.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10038.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 1", "code_information": [ { "code": "3411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3449.71, "maximum": 6209.48, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 3794.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 3794.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3794.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6209.48, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3449.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Fentanyl 0.2 Mg/100Ml-Bupiv 0.125%-Nacl 0.9% Epidural Inj", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "61553012448", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 4", "code_information": [ { "code": "0824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15037.55, "maximum": 27067.59, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15037.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16541.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16541.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15037.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16541.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15037.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15037.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27067.59, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15037.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15037.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 1", "code_information": [ { "code": "3421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4721.66, "maximum": 8498.99, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4721.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5193.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5193.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4721.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5193.83, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4721.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4721.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8498.99, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4721.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4721.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc (Sup Shell A4315) Cath W/Drainage 2-Way Silcne", "code_information": [ { "code": "A4315", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 57.72, "10th_percentile": 57.72, "90th_percentile": 57.72, "count": "1 through 10" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 1", "code_information": [ { "code": "0921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10998.75, "maximum": 19797.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10998.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 12098.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 12098.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10998.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 12098.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10998.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10998.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19797.75, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10998.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10998.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 2", "code_information": [ { "code": "3422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5659.17, "maximum": 10186.51, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5659.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6225.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6225.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5659.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6225.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5659.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5659.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10186.51, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5659.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5659.17, "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": 21691.49, "maximum": 39044.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21691.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 23860.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 23860.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21691.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 23860.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 21691.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21691.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39044.68, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 21691.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21691.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7644, "minimum": 6457.82, "maximum": 12600, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 11743.43 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9937.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6845.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10009.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12230.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9646.78 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7644.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7219.21 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7644.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6457.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6780.71, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Fluphenazine Hcl Inj 2.5 Mg/Ml", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "63323028110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 39.33, "median_amount": 116.11, "10th_percentile": 116.11, "90th_percentile": 689.69, "count": "1 through 10" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 3", "code_information": [ { "code": "5313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5721.17, "maximum": 10298.11, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5721.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6293.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6293.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5721.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6293.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5721.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5721.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10298.11, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5721.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5721.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20026, "minimum": 4123.32, "maximum": 32042.944, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 23119.94 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26034.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 17785.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 26007.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32042.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26405.62 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20026.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4123.32 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 20026.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16779, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 17617.95, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 4", "code_information": [ { "code": "5314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8783.85, "maximum": 15810.93, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8783.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9662.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9662.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8783.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9662.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8783.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8783.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15810.93, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8783.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8783.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 3", "code_information": [ { "code": "5303", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8062.77, "maximum": 14512.99, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8062.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8869.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8869.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8062.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8869.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8062.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8062.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14512.99, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8062.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8062.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9172, "minimum": 7731.23, "maximum": 18576.813, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 18576.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11923.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11983.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14675.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11714.46 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9907.29 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9172.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7731.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8117.79, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 4", "code_information": [ { "code": "5304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13732.43, "maximum": 24718.37, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 15105.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 15105.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15105.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24718.37, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13732.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13732.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 1", "code_information": [ { "code": "2461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4392.66, "maximum": 7906.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4392.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4831.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4831.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4392.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4831.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4392.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4392.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 7906.79, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4392.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4392.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 2", "code_information": [ { "code": "3142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8890.43, "maximum": 16002.77, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8890.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9779.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9779.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8890.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9779.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8890.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8890.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16002.77, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8890.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8890.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25150, "minimum": 21049.4, "maximum": 46438.527, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 46438.53 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32695.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 22312.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 32626.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 40240.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33339.69 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25150.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33277.7 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 25150.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 22101.87, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8351, "minimum": 7047.08, "maximum": 13753.245, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13753.25 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10856.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7469.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 10922.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13362.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10603.58 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8351.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7154.64 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8351.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7047.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7399.43, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 Mg/2Ml (0.2 Mg/Ml)", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "00517460225", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 45, "median_amount": 0.23, "10th_percentile": 0.23, "90th_percentile": 0.23, "count": "1 through 10" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 4", "code_information": [ { "code": "7224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10707.81, "maximum": 19274.06, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10707.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 11778.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 11778.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10707.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 11778.59, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10707.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10707.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 19274.06, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 10707.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10707.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 1", "code_information": [ { "code": "3161", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7020.85, "maximum": 12637.53, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 7722.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 7722.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7722.94, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12637.53, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7020.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7020.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 1", "code_information": [ { "code": "3401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3648.75, "maximum": 6567.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3648.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 4013.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 4013.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3648.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4013.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 3648.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3648.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 6567.75, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 3648.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3648.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 2", "code_information": [ { "code": "3162", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7663.62, "maximum": 13794.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7663.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8429.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8429.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7663.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8429.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 7663.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7663.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13794.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 7663.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7663.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 2", "code_information": [ { "code": "3402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4605.29, "maximum": 8289.52, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4605.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5065.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5065.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4605.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5065.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4605.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4605.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8289.52, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4605.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4605.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bladder Instillation Anticarcinogenic Agent", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 987.27, "discounted_cash": 691, "minimum": 197.4, "maximum": 987.27, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 843.4 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 968.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 987.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 680.8, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 691.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 726.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 4", "code_information": [ { "code": "3414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16516.68, "maximum": 29730.02, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16516.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 18168.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 18168.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16516.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 18168.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16516.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16516.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29730.02, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16516.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16516.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Fixation of ankle joint", "code_information": [ { "code": "27860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2675.98, "discounted_cash": 3245, "minimum": 535.05, "maximum": 2675.98, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2282.77 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2675.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 4", "code_information": [ { "code": "3424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13183.73, "maximum": 23730.71, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13183.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 14502.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 14502.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13183.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 14502.1, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 13183.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13183.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23730.71, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 13183.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13183.73, "additional_payer_notes": "100% of State Medicaid 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": 63820, "minimum": 38972.2, "maximum": 102650.388, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 63820.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 55946.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 102650.39 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 82967.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 56479.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 82588.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 102113.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 85677.9 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 53282.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63820.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38972.2 } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 4", "code_information": [ { "code": "3144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16277.41, "maximum": 29299.34, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16277.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 17905.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 17905.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16277.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 17905.15, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16277.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16277.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29299.34, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 16277.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16277.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17013, "minimum": 14267.5, "maximum": 32559.084, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 32559.08 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22117.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15123.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 22114.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27222, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22327.59 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17013.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21561.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17013.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14267.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14980.88, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 3", "code_information": [ { "code": "3403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8146.52, "maximum": 14663.74, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8146.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 8961.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 8961.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8146.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8961.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8146.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8146.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14663.74, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8146.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8146.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16650, "minimum": 13964.4, "maximum": 28345.473, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 28345.47 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21645.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 14802.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 21644.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26640.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21835.46 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16650.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19190.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 16650.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13964.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 14662.62, "additional_payer_notes": "105.00% 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": 4739.61, "maximum": 8531.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4739.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 5213.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 5213.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4739.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5213.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 4739.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4739.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 8531.3, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 4739.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4739.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6080, "minimum": 5154.25, "maximum": 13697.157, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 13697.16 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7904.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7989.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9728.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7530.13 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6080.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7728.96 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 6080.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5154.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 5411.96, "additional_payer_notes": "105.00% 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": 9742.02, "maximum": 17535.64, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 10716.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 10716.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 10716.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17535.64, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 9742.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7487, "minimum": 6326.88, "maximum": 13500, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 12220.17 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9733.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 6706.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 9806.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11979.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9434.16 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7487.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6541.8 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 7487.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6326.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 6643.22, "additional_payer_notes": "105.00% 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": 8420, "minimum": 7104.46, "maximum": 16277.205, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 16277.21 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10946.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 7530.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 11011.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13472.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10696.75 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8331.6 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 8420.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7104.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.68, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13550, "minimum": 11380.8, "maximum": 22063.617, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 22063.62 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17615.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12063.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 17640.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21680.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17640.38 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13550.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14174.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 13550.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11380.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 11949.84, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14352, "minimum": 12049.5, "maximum": 24879.702, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 24879.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18658.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12772.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18676.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22964.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18726.18 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19173.5 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14352.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12049.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12651.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 3", "code_information": [ { "code": "2463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8293.34, "maximum": 14928.01, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8293.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 9122.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 9122.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8293.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 9122.67, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 8293.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8293.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14928.01, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 8293.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8293.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11831, "minimum": 9947.74, "maximum": 19345.686, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 19345.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15380.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 10544.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 15419, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18930.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15313.49 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16722.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 11831.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 10445.13, "additional_payer_notes": "105.00% 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": 28942, "minimum": 19736.4, "maximum": 47700.507, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 47700.51 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 37625.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 25663.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 37526.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 46308.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38472.46 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28942.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19736.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 28942.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24210.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 25421.03, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5317, "minimum": 4518.66, "maximum": 10350, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 9548.98 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 6913.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 4789.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 7003.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8508.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6498.08 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5317.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4848.3 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 5317.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4518.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 4744.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9539, "minimum": 8037.26, "maximum": 17193.309, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 17193.31 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12401.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 8519.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 12457.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15262.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12211.37 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9539.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11032.2 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 9539.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8037.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 8439.12, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 2", "code_information": [ { "code": "2462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5795.67, "maximum": 10432.21, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5795.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 6375.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 6375.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5795.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 6375.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 5795.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5795.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 10432.21, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 5795.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5795.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Low Cost Skin Substitute App", "code_information": [ { "code": "C5275", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1024, "discounted_cash": 594, "minimum": 204.74, "maximum": 1024, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.57, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.98 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.57, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 832.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.57, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.43, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.57, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 921.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.57, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 584.98, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 318.57, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 318.57, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 594.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 624.04, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 4", "code_information": [ { "code": "2464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15376.34, "maximum": 27677.41, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15376.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "case rate", "standard_charge_dollar": 16913.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "case rate", "standard_charge_dollar": 16913.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15376.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 16913.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "case rate", "standard_charge_dollar": 15376.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15376.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "case rate", "standard_charge_dollar": 27677.41, "additional_payer_notes": "180% of State Medicaid Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "case rate", "standard_charge_dollar": 15376.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15376.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Open Tx Articular Fracture Mcp/Ip Joint Ea", "code_information": [ { "code": "26746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14152, "discounted_cash": 3245, "minimum": 1739.7495, "maximum": 14152, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2663.22 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4543.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1913.73, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3440.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5030.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3194.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1739.75, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3245.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3407.93, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.35, "minimum": 30.39, "maximum": 244.35, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.39 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 73.31, "10th_percentile": 73.31, "90th_percentile": 21290.76, "count": "1 through 10" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14411, "minimum": 12098, "maximum": 24433.335, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 24433.34 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18734.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 12823.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 18751.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23057.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18805.01 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14411.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17603.4 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 14411.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12098, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 12702.9, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17853, "minimum": 14400, "maximum": 36943.296, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "case rate", "standard_charge_dollar": 36943.3 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23208.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "case rate", "standard_charge_dollar": 15865.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "case rate", "standard_charge_dollar": 23199.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28564.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23463.56 }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17853.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21090.1 }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "case rate", "standard_charge_dollar": 17853.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14967.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "case rate", "standard_charge_dollar": 15715.46, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Dup-Scan Artl Infl&Ven O/F Pen Vsl Compl", "code_information": [ { "code": "93980", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 752.5, "discounted_cash": 103, "minimum": 55.5858, "maximum": 752.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 752.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.14, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.14, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.14, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.07, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 55.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 103.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4223) Infusion Supplies W/O Pump", "code_information": [ { "code": "A4223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 4.5, "10th_percentile": 4.5, "90th_percentile": 8.52, "count": "1 through 10" } ] } ] }, { "description": "Hc Prgrmg Dev Eval Scrms Phys/Qhp In Person", "code_information": [ { "code": "93285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.75, "discounted_cash": 37, "minimum": 19.8436, "maximum": 175.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.44, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.87, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4606) Oxygen Probe Used W Oximeter", "code_information": [ { "code": "A4606", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 60, "10th_percentile": 60, "90th_percentile": 60, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 67.6, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1726) Catheter Balloon Dilat Non-Vascular", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 957.12, "10th_percentile": 957.12, "90th_percentile": 957.12, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4556) Electrodes, Pair", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 150.18, "10th_percentile": 150.18, "90th_percentile": 150.18, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1729) Catheter Drainage", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 317.2, "10th_percentile": 317.2, "90th_percentile": 317.2, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4565) Slings - A4565 - 27400063", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 33.06, "10th_percentile": 33.06, "90th_percentile": 33.06, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4649) Surgical Supplies - A4649 - RU272005", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 60.11, "10th_percentile": 35.22, "90th_percentile": 120.22, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4657) Syringe W/Wo Needle", "code_information": [ { "code": "A4657", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 2, "10th_percentile": 2, "90th_percentile": 4.4, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1781) Mesh", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1097.98, "10th_percentile": 1097.98, "90th_percentile": 1796.44, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6450) Lt Compres Band >=5/Yd - A6450 - 27090040", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 10.56, "10th_percentile": 10.56, "90th_percentile": 10.56, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1887) Catheter Guiding", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 236.88, "10th_percentile": 236.88, "90th_percentile": 236.88, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1894) Intrducr/Sheath Not Guid Non-Lasr", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 379.6, "10th_percentile": 379.6, "90th_percentile": 379.6, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1713) Anchr/Screw Oppos Bn-Bn/Sft Tiss-Bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 4702.56, "10th_percentile": 1624.8, "90th_percentile": 11384.8, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6457) Tubular Dressing - A6457 - 27090041", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 20.88, "10th_percentile": 20.88, "90th_percentile": 20.88, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1776) Joint Device", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 18800, "10th_percentile": 18800, "90th_percentile": 18800, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1755) Catheter Intraspinal", "code_information": [ { "code": "C1755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 994.24, "10th_percentile": 994.24, "90th_percentile": 4993.65, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1769) Guide Wire", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 60.06, "10th_percentile": 60.06, "90th_percentile": 1153.67, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C2617) Stent Non-Cor Temp W/O Deliv System", "code_information": [ { "code": "C2617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 2079.69, "10th_percentile": 2079.69, "90th_percentile": 2079.69, "count": "1 through 10" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2113.75, "discounted_cash": 236, "minimum": 126.861, "maximum": 2113.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1514.28 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 139.55, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 331.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 139.55, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 139.55, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 232.95, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 126.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 236.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 248.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.86, "additional_payer_notes": "53.60% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23175.7, "discounted_cash": 7736, "minimum": 2460.02, "maximum": 23175.7, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4147.15, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2460.02 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4147.15, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4561.87, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10831.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4561.87, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4147.15, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4561.87, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8201.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4147.15, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11992.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4147.15, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7615.31, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 4147.15, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4147.15, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7736.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8123.7, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 18, "minimum": 9.6232, "maximum": 92, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.9, "discounted_cash": 46, "minimum": 20.5, "maximum": 173.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.21 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.71, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.76, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.45, "discounted_cash": 5, "minimum": 2.7301, "maximum": 14.45, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.52 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 3.82, "10th_percentile": 3.82, "90th_percentile": 91.72, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.69, "discounted_cash": 14, "minimum": 4.34, "maximum": 21.69, "payers_information": [ { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.2, "discounted_cash": 13, "minimum": 7.0291, "maximum": 67.2, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.2 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.97, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14618.2, "discounted_cash": 3132, "minimum": 160.58, "maximum": 14618.2, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.58 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4507, "discounted_cash": 3132, "minimum": 151.57, "maximum": 14894.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4507, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14894.9, "discounted_cash": 3132, "minimum": 151.57, "maximum": 14894.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.94, "discounted_cash": 4, "minimum": 2.4842, "maximum": 70.94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67, "discounted_cash": 4, "minimum": 2.4842, "maximum": 67, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I High Definition Panel Qual", "code_information": [ { "code": "86832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 864.15, "discounted_cash": 323, "minimum": 169.3212, "maximum": 864.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.07 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.25, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 453.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.25, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.25, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.35, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 169.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 339.94, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody John Cunningham Virus", "code_information": [ { "code": "86711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94, "discounted_cash": 16, "minimum": 8.8335, "maximum": 94, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.4, "discounted_cash": 10, "minimum": 4.08, "maximum": 20.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.76 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10687.5, "discounted_cash": 2046, "minimum": 1097.0609, "maximum": 10687.5, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2014.5, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2148.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5211.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1206.77, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2169.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3172.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1097.06, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2046.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 277, "minimum": 148.7094, "maximum": 1103.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.91 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 388.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.07, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705.9, "discounted_cash": 161, "minimum": 86.4019, "maximum": 705.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.96 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705.9, "discounted_cash": 161, "minimum": 86.4019, "maximum": 705.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.36 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.75, "discounted_cash": 161, "minimum": 86.4019, "maximum": 625.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.25, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Short Leg Cast,Walker", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1279.4, "discounted_cash": 277, "minimum": 148.7094, "maximum": 1279.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 323.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 388.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.07, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154, "discounted_cash": 36, "minimum": 19.1313, "maximum": 154, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.17 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.41, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20, "discounted_cash": 58, "minimum": 4, "maximum": 25, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.69 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1456.3, "discounted_cash": 355, "minimum": 19.33, "maximum": 1456.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.33 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.65, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.65, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.65, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 376.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.97, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 190.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.59, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 355.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 125.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 373.34, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Cath Prolngd Nfs Ther Chemotx Cutdown", "code_information": [ { "code": "36640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14894.9, "discounted_cash": 3132, "minimum": 1678.8625, "maximum": 14894.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2389.11 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399, "discounted_cash": 346, "minimum": 79.78, "maximum": 399, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.62, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 363.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspiration And/Or Injection Thyroid Cyst", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978, "discounted_cash": 702, "minimum": 130.2, "maximum": 978, "payers_information": [ { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 744.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 978, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 691.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 737.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.2 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 702.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 978, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.17, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 376.51, "additional_payer_notes": "53.60% of Medicare Rates" } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65, "discounted_cash": 18, "minimum": 9.4454, "maximum": 65, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.09 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 19, "minimum": 10.2665, "maximum": 100, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 30, "10th_percentile": 30, "90th_percentile": 30, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "discounted_cash": 3, "minimum": 2.0554, "maximum": 99.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.16 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.26, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.26, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.26, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.79, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.35, "discounted_cash": 16, "minimum": 8.7184, "maximum": 83.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.61 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2019-Ncov Diagnostic P", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 0.01, "discounted_cash": 51, "minimum": 1, "maximum": 256.55, "payers_information": [ { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.62 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Myeloperoxidase", "code_information": [ { "code": "83876", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.58, "discounted_cash": 50, "minimum": 26.5998, "maximum": 152.58, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 827, "minimum": 36.77, "maximum": 827, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.77 } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3814.4, "discounted_cash": 777, "minimum": 416.813, "maximum": 3814.4, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1113.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.49, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1088.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.49, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.49, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1205.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 765.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 748.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 816.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.44, "minimum": 39.88, "maximum": 199.44, "payers_information": [ { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 159.55, "10th_percentile": 159.55, "90th_percentile": 159.55, "count": "1 through 10" } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 704.5, "discounted_cash": 300, "minimum": 140.86, "maximum": 704.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.9, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.98 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.9, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.59, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.59, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.9, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.59, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 318, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.9, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 465, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.9, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.44, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 156.9, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.9, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp&Postproc Diff Work Statio", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1260, "minimum": 94.54, "maximum": 1260, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.54 } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2113.75, "discounted_cash": 777, "minimum": 416.813, "maximum": 2113.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1113.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.49, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1088.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.49, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.49, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1205.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 765.38, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 777.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 748.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 816.48, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - G0480 - 30100036", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.44, "discounted_cash": 114, "minimum": 1.2, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.9 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.4, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Modlg Antb", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 12, "minimum": 6.3022, "maximum": 92, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3929.6, "discounted_cash": 899, "minimum": 482.251, "maximum": 3929.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 785.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 953.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1394.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 1571.84, "10th_percentile": 1571.84, "90th_percentile": 1571.84, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 885.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2414.15, "discounted_cash": 899, "minimum": 482.251, "maximum": 2414.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 932.67 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 530.48, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 953.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1394.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 885.55, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.25, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 899.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 944.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.1, "discounted_cash": 38, "minimum": 20.1983, "maximum": 193.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 57.93, "10th_percentile": 57.93, "90th_percentile": 57.93, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.26, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145, "discounted_cash": 12, "minimum": 6.731, "maximum": 145, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.42, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.25, "discounted_cash": 46, "minimum": 13.65, "maximum": 68.25, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.25 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.71, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.76, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 18, "minimum": 9.6232, "maximum": 92, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.44 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.99, "discounted_cash": 14, "minimum": 7.6201, "maximum": 101.99, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.4 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.35, "discounted_cash": 16, "minimum": 8.4046, "maximum": 80.35, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.98 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Hearing Status Deter Broadband Stimuli I&R", "code_information": [ { "code": "92651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 697.75, "discounted_cash": 214, "minimum": 114.8058, "maximum": 697.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 697.75 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.29, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 299.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.29, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 126.29, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 331.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.81, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 214.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.89, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.45, "discounted_cash": 12, "minimum": 5.29, "maximum": 26.45, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - G0480 - 30100323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.5, "discounted_cash": 114, "minimum": 1.2, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.5 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.4, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.5, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Resistance By Impulse Oscillometry", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1400.3, "discounted_cash": 127, "minimum": 68.4129, "maximum": 1400.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.41, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.25 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.41, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.25, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.25, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.41, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.25, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.41, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.41, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.62, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 68.41, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.41, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 127.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.01, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120, "discounted_cash": 11, "minimum": 6.2655, "maximum": 120, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.65, "discounted_cash": 15, "minimum": 7.33, "maximum": 36.65, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.19 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.4, "discounted_cash": 13, "minimum": 7.1546, "maximum": 68.4, "payers_information": [ { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 27.36, "10th_percentile": 27.36, "90th_percentile": 27.36, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.2, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54, "discounted_cash": 7, "minimum": 4.1683, "maximum": 54, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.85, "discounted_cash": 16, "minimum": 8.7707, "maximum": 83.85, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 12.28, "10th_percentile": 12.28, "90th_percentile": 33.54, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.75, "discounted_cash": 16, "minimum": 8.823, "maximum": 67.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29, "discounted_cash": 7, "minimum": 4.0899, "maximum": 29, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.54, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4655.53, "discounted_cash": 3132, "minimum": 226.61, "maximum": 4655.53, "payers_information": [ { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4655.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.61 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Pneumococcal Vac - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268, "discounted_cash": 46, "minimum": 24.893, "maximum": 268, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.21 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.71, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 30.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.76, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.95, "discounted_cash": 13, "minimum": 7.003, "maximum": 66.95, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Androstanediol Glucuronide", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159, "discounted_cash": 28, "minimum": 15.0781, "maximum": 159, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.46 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12802.1, "discounted_cash": 3132, "minimum": 132.06, "maximum": 12802.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.06 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1002.79, "discounted_cash": 217, "minimum": 116.43, "maximum": 1002.79, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.07, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.07, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.07, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 336.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 401.12, "10th_percentile": 329.26, "90th_percentile": 401.12, "count": "27" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.8, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.43, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.07, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogens", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281, "discounted_cash": 32, "minimum": 16.8929, "maximum": 281, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.14 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.16, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% 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": 4137.6, "discounted_cash": 3132, "minimum": 827.29, "maximum": 4137.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4137.6 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4137.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4137.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7995.68, "discounted_cash": 5519, "minimum": 152.32, "maximum": 7995.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.32 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7727.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5850.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7995.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5432.96, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5795.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 355, "discounted_cash": 64, "minimum": 33.6864, "maximum": 355, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.06 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.06, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.06, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.06, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethosuximide", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.51, "discounted_cash": 16, "minimum": 4.9, "maximum": 24.51, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 64, "minimum": 14, "maximum": 70, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.93, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2839.45, "minimum": 113.3, "maximum": 2839.45, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.3 } ] } ] }, { "description": "Hc Amino Acids, 6+ Quant", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.81, "discounted_cash": 16, "minimum": 8.823, "maximum": 101.81, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fentanyl - G0480 - 30100020", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20, "discounted_cash": 114, "minimum": 1.2, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.07, "discounted_cash": 12, "minimum": 6.3022, "maximum": 84.07, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14308.3, "discounted_cash": 3132, "minimum": 151.57, "maximum": 14894.9, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.47, "discounted_cash": 22, "minimum": 6.89, "maximum": 34.47, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.29 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.02, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 13, "minimum": 7.1285, "maximum": 200, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.4 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 195.6, "10th_percentile": 195.6, "90th_percentile": 195.6, "count": "1 through 10" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 9.98, "10th_percentile": 9.98, "90th_percentile": 80, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.7, "discounted_cash": 11, "minimum": 4.74, "maximum": 23.7, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22981, "discounted_cash": 5519, "minimum": 210.09, "maximum": 22981, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.09 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7727.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5850.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8555.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5432.96, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5795.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 895.09, "discounted_cash": 913, "minimum": 178.97, "maximum": 895.09, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 895.09 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.7, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.73, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 895.09, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.3, "discounted_cash": 16, "minimum": 8.6086, "maximum": 82.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 12.05, "10th_percentile": 12.05, "90th_percentile": 12.05, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2750, "discounted_cash": 504, "minimum": 263.592, "maximum": 2750, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.59, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 532.53 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.59, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.95, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.95, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.59, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 289.95, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.59, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.59, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.26, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 263.59, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.59, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - G0278 - 32300016", "code_information": [ { "code": "G0278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14894.9, "minimum": 29.26, "maximum": 14894.9, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.26 } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5066, "discounted_cash": 3132, "minimum": 253.61, "maximum": 5066, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.61 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.57, "discounted_cash": 16, "minimum": 4.91, "maximum": 24.57, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apc Gene Analysis Duplication/Deletion Variants", "code_information": [ { "code": "81203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300, "discounted_cash": 200, "minimum": 59.98, "maximum": 300, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.6, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.32 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.6, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.06, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.06, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.6, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.06, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.6, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.6, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.96, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 104.6, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.6, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.2, "discounted_cash": 13, "minimum": 6.9245, "maximum": 66.2, "payers_information": [ { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortobifemoral W Cath", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6207.37, "discounted_cash": 3132, "minimum": 143.32, "maximum": 6207.37, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.32 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.89, "discounted_cash": 7, "minimum": 3.7656, "maximum": 18.89, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 5.27, "10th_percentile": 5.27, "90th_percentile": 5.27, "count": "1 through 10" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.95, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apc Gene Analysis Full Gene Sequence", "code_information": [ { "code": "81201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170, "discounted_cash": 780, "minimum": 233.94, "maximum": 1170, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.94, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 824.15 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.94, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.73, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1092, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.73, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.94, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.73, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 826.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.94, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1170, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.94, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 752.54, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 407.94, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.94, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 780, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 819, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14, "discounted_cash": 169, "minimum": 2.8, "maximum": 745.8, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.04 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6207.37, "discounted_cash": 3132, "minimum": 160.58, "maximum": 6207.37, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.58 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4384.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1846.75, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3319.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4854.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3082.85, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1678.86, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 3132.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3288.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucagon", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.1, "discounted_cash": 14, "minimum": 3.42, "maximum": 17.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632, "minimum": 116.99, "maximum": 632, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.99 } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.5, "discounted_cash": 7, "minimum": 3.8179, "maximum": 36.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Spinal Selectv", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7995.68, "discounted_cash": 5519, "minimum": 314.39, "maximum": 7995.68, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 314.39 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7727.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5850.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7995.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5432.96, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5795.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemosiderin, Qual", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.5, "discounted_cash": 4, "minimum": 2.4842, "maximum": 23.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.8, "discounted_cash": 131, "minimum": 70.7392, "maximum": 575.8, "payers_information": [ { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.9, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "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": 1427.77, "minimum": 285.48, "maximum": 1427.77, "payers_information": [ { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.7 } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11284, "discounted_cash": 5519, "minimum": 174.07, "maximum": 11284, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.07 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7727.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3254.56, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5850.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8555.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5432.96, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2958.69, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 5519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5795.66, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Inorganic Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.3, "discounted_cash": 4, "minimum": 2.479, "maximum": 84.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 33.72, "10th_percentile": 33.72, "90th_percentile": 33.72, "count": "24" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.48, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 277, "minimum": 148.7094, "maximum": 1103.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.26 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 388.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.07, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.75, "discounted_cash": 131, "minimum": 70.7392, "maximum": 559.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.58 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.9, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.57, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.3, "discounted_cash": 14, "minimum": 6.86, "maximum": 34.3, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.43 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71, "discounted_cash": 12, "minimum": 6.7729, "maximum": 71, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.49, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3242.6, "discounted_cash": 700, "minimum": 375.3193, "maximum": 3242.6, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.32, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 869.02 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.32, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 412.85, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 980.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 412.85, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.32, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 412.85, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 742.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.32, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1085.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.32, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 689.19, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 375.32, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.32, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 700.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 735.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.75, "discounted_cash": 131, "minimum": 70.7392, "maximum": 559.75, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.32 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.81, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.9, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.74, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 131.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.57, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 42, "minimum": 10, "maximum": 50, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "A Indicator - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "A Indicator - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "A Indicator - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.55, "discounted_cash": 12, "minimum": 6.3335, "maximum": 60.55, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocnt Aspir&/Inj Small Jt/Bursaw/Us Rec Rprt", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1334.15, "discounted_cash": 304, "minimum": 163.2035, "maximum": 1334.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.7 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.52, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 426.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.52, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.52, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 322.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 299.69, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 163.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.2, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 304.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.69, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1199.55, "discounted_cash": 277, "minimum": 148.7094, "maximum": 1199.55, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.99 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 388.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.07, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1326.25, "discounted_cash": 346, "minimum": 185.4968, "maximum": 1326.25, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.1 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 484.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.62, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 363.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162, "discounted_cash": 6, "minimum": 3.6035, "maximum": 162, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.96, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.96, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.96, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 64.8, "10th_percentile": 64.8, "90th_percentile": 64.8, "count": "67" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520, "discounted_cash": 346, "minimum": 103.97, "maximum": 520, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.82 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 484.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.62, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 363.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.7, "discounted_cash": 161, "minimum": 86.4019, "maximum": 668.7, "payers_information": [ { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.66, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.4, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.04, "additional_payer_notes": "58.96% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.91, "discounted_cash": 8, "minimum": 4.524, "maximum": 129.91, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.14 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 45, "median_amount": 58.46, "10th_percentile": 58.46, "90th_percentile": 58.46, "count": "1 through 10" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 51.96, "10th_percentile": 51.96, "90th_percentile": 51.96, "count": "12" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.9, "discounted_cash": 6, "minimum": 3.5041, "maximum": 46.9, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health HMO and PPO (08-01-2020 to 12-31-2026)", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 18.76, "10th_percentile": 2.28, "90th_percentile": 18.76, "count": "53" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.46, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399, "discounted_cash": 346, "minimum": 79.78, "maximum": 399, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.35 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.62, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 363.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Short Leg Cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1002.5, "discounted_cash": 277, "minimum": 148.7094, "maximum": 1002.5, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 323.57 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 388.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.58, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 430.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.07, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii High Definition Panel Qual", "code_information": [ { "code": "86833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400, "discounted_cash": 325, "minimum": 79.98, "maximum": 400, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.39, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.24 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.39, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.43, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.43, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.39, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.43, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.39, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.39, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 314.33, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 170.39, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.39, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25, "discounted_cash": 16, "minimum": 5, "maximum": 25, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.91 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520, "discounted_cash": 346, "minimum": 103.97, "maximum": 520, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.07 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 484.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.05, "additional_payer_notes": "58.96% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.62, "additional_payer_notes": "98.43% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 185.5, "additional_payer_notes": "53.60% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 346.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 363.36, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.1, "discounted_cash": 12, "minimum": 4.82, "maximum": 24.1, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.74 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Serotonergic Class 1 Or 2 - G0480 - 31080332", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.71, "discounted_cash": 114, "minimum": 1.2, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.71 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162, "discounted_cash": 114, "minimum": 1.2, "maximum": 572.15, "payers_information": [ { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.4, "additional_payer_notes": "Laboratory - 96.48% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Total Health Care Priority Health", "plan_name": "Total Health Care Priority Health MIChild", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% 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 VA CCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing", "plan_name": "Zing Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.9 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.83, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Honest HMO", "plan_name": "Honest HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana Behavioral Health", "plan_name": "Humana Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity HP", "plan_name": "Longevity HP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Mclaren Health Plan", "plan_name": "Mclaren Health Plan MICHILD Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Naphcare Residential Inmate Treatment Center", "plan_name": "Naphcare Residential Inmate Treatment Center Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Priority Health", "plan_name": "Priority Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.85, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Reliance HMO Medicare Advantage", "plan_name": "Reliance HMO Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Sunrise", "plan_name": "Sunrise Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.25, "discounted_cash": 15, "minimum": 7.8712, "maximum": 75.25, "payers_information": [ { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Aetna Better Health Coventry Cares", "plan_name": "Aetna Better Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS MI", "plan_name": "BCBS Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.91 }, { "payer_name": "BCBS MI", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Beacon Health Strategies", "plan_name": "Beacon Health Strategies Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 52.30% of Medicare Rates" }, { "payer_name": "Community Care Associates Medicaid", "plan_name": "Community Care Associates Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - Health Choice Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "Laboratory - 57.53% of Medicare Rates" }, { "payer_name": "Harbor Health Plan", "plan_name": "Harbor Health Plan - MEDBASIC Medicaid",