{ "hospital_name": "St Joseph Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "St Joseph Medical Center" ], "hospital_address": [ "1000 Carondelet Drive Kansas City, MO 64114" ], "license_information": { "license_number": "471669781", "state": "MO" }, "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": "Jodi Fincher" }, "type_2_npi": [ "1528463080", "1558767624", "1376031757" ], "standard_charge_information": [ { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12757, "minimum": 6580, "maximum": 46375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22707.82, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17750.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12303.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12757.2, "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": 16584.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13395.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 17222.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17222.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13395.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13395.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14032.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6613.91 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17860.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8375.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12757.2, "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": 12757.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": " - 0054T - ", "code_information": [ { "code": "0054T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13217.52, "minimum": 1662, "maximum": 13217.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7716, "minimum": 3158.61, "maximum": 15750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13735.8, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10427.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7227.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7716.74, "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": 10031.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8102.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10417.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10417.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8102.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8102.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8488.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7331.03 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10803.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3158.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7716.74, "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": 7716.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": " - S2900 - ", "code_information": [ { "code": "S2900", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12259.1, "minimum": 3131, "maximum": 12259.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3131 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15469, "minimum": 6580, "maximum": 36750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27535.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21690.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15034.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15469.26, "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": 20110.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15469.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16242.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 20883.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20883.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16242.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16242.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17016.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15469.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17331.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21656.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6991.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15469.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15469.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15469.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15469.26, "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": 15469.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6561, "minimum": 3584.49, "maximum": 17500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11679.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8748.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6064.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6561.48, "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": 8529.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6889.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8858, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8858, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6889.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6889.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7217.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3939.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9186.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3584.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6561.48, "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": 6561.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39834, "minimum": 6580, "maximum": 87500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 70906.05, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 57089.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39834.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39571.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 39834.86, "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": 51785.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 39834.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 41826.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 53777.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53777.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39834.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 41826.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 41826.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 43818.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39834.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39834.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78210.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 55768.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 18419.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39834.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 39834.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 39834.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39834.86, "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": 39834.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19909, "minimum": 6580, "maximum": 62125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 35439.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 28141.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19909.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19506.29 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 19909.91, "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": 25882.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 19909.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 20905.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 26878.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26878.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19909.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 20905.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 20905.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21900.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19909.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19909.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25679.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 27873.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13273.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19909.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 19909.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 19909.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19909.91, "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": 19909.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8866, "minimum": 4146.46, "maximum": 36750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15781.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12097.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8385.07 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8866.27, "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": 11526.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9309.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11969.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11969.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9309.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9309.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9752.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4146.46 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12412.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8866.27, "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": 8866.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14717, "minimum": 6580, "maximum": 26197.506, "payers_information": [ { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15453.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16189.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24285.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20604.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9724.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14717.7, "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": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26197.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20598.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14277.61 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14717.7, "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": 19133.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15453.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 19868.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19868.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14717.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15453.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7194, "minimum": 4542.72, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12805.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9667.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6701.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7194.22, "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": 9352.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7553.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9712.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9712.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7553.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7553.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7913.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9332.98 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10071.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4542.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7194.22, "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": 7194.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6164, "minimum": 2658.96, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10972.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8171.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5664.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6164.23, "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": 8013.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6472.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8321.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8321.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6472.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6472.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6780.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2658.96 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8629.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2803.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6164.23, "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": 6164.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7412, "minimum": 2145, "maximum": 13194.3034, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13194.3, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9985.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6921.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7412.53, "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": 9636.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7783.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10006.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10006.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7783.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7783.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8153.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5641.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10377.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3371.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7412.53, "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": 7412.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16227, "minimum": 6580, "maximum": 28885.8044, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28885.8, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22792.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16228, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15798.49 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 16227.98, "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": 21096.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 16227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17039.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 21907.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21907.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16228, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17039.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 17039.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17850.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16228, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23349.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22719.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8730.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16228, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 16227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 16227.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16227.98, "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": 16228, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12021, "minimum": 6352.71, "maximum": 35875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21398.07, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16681.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12021.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11562.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12021.39, "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": 15627.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12021.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12622.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16228.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16228.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12021.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12622.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12622.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13223.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12021.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12021.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13083.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16829.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6352.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12021.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12021.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12021.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12021.39, "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": 12021.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7118, "minimum": 6068.79, "maximum": 21875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12670.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9557.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6624.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7118.35, "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": 9253.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7474.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9609.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9609.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7474.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7474.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7830.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8820.25 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9965.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6068.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7118.35, "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": 7118.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9268, "minimum": 4081.35, "maximum": 23625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16497.98, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12681.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8790.16 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9268.53, "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": 12049.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9731.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12512.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12512.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9731.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9731.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10195.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12113.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12975.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4081.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9268.53, "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": 9268.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13030, "minimum": 4042.5, "maximum": 23194.5214, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23194.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18147.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12578.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13030.63, "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": 16939.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13030.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13682.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 17591.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17591.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13682.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13682.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14333.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13030.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10068.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18242.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7559.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13030.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13030.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13030.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13030.63, "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": 13030.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10555, "minimum": 5571.93, "maximum": 18788.7722, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18788.77, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14551.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10086.15 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10555.49, "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": 13722.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10555.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11083.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14249.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14249.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11083.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11083.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11611.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14159.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14777.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5571.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10555.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10555.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10555.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10555.49, "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": 10555.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5715, "minimum": 5082.7, "maximum": 15750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10173.48, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7519.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5212.1 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5715.44, "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": 7430.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7715.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7715.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6001.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6001.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6286.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7911.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8001.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5784.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5715.44, "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": 5715.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6858, "minimum": 2805, "maximum": 12208.1834, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12208.18, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9180.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6363.22 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6858.53, "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": 8916.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7201.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9259.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9259.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7201.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7201.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7544.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9601.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3868.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6858.53, "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": 6858.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9055, "minimum": 6580, "maximum": 37625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16118.31, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12371.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8575.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9055.23, "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": 11771.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9507.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12224.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12224.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9507.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9507.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9960.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21185.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12677.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13628.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9055.23, "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": 9055.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5494, "minimum": 3407.04, "maximum": 14000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9779.78, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7198.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4989.38 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5494.26, "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": 7142.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5768.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7417.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7417.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5768.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5768.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6043.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7063.93 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7691.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3407.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5494.26, "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": 5494.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4955, "minimum": 1650, "maximum": 8820.4162, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8820.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6415.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4446.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 4955.29, "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": 6441.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5203.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6689.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6689.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5203.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5203.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5450.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3313.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6937.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2413.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4955.29, "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": 4955.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8600, "minimum": 6580, "maximum": 32375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15308, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11710.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8116.93 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8600, "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": 11180, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9030, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11610, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11610, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9030, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9030, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9460, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13395.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12040, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9617.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8600, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8600, "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": 8600, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4826, "minimum": 2945.67, "maximum": 10500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8591.08, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6227.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4316.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 4826.45, "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": 6274.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5067.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6515.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6515.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5067.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5067.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5309.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5352.27 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6757.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2945.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4826.45, "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": 4826.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 86560, "minimum": 6580, "maximum": 316312.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 154077.6, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 124974.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 86560.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 86625.02 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 86560.45, "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": 112528.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 86560.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 90888.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 116856.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 116856.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 86560.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 90888.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 90888.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 95216.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 86560.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 86560.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 100873 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 121184.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 42942.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 86560.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 86560.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 86560.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 86560.45, "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": 86560.4, "additional_payer_notes": "100.00% 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": 6293, "minimum": 5500.95, "maximum": 23625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11202.93, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8359.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5794.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6293.78, "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": 8181.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6608.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8496.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8496.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6608.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6608.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6923.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8580.64 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8811.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5500.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6293.78, "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": 6293.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33196, "minimum": 6580, "maximum": 59089.0046, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 59089, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47444.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33196.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 32885.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 33196.07, "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": 43154.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 33196.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 34855.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 44814.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44814.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33196.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 34855.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 34855.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 36515.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 33196.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33196.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46585.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 46474.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 18277.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33196.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 33196.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 33196.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33196.07, "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": 33196.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5032, "minimum": 4524.46, "maximum": 26250, "payers_information": [ { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6794, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5284.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5284.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5535.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16913.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7045.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4968.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5032.59, "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": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8958.01, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6527.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4524.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5032.59, "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": 6542.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5032.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5284.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6794, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10672, "minimum": 6139.77, "maximum": 18996.4448, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18996.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14720.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10672.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10203.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10672.16, "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": 13873.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10672.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11205.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14407.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14407.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10672.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11205.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11205.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11739.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10672.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10672.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6321.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14941.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6139.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10672.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10672.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10672.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10672.16, "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": 10672.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13888, "minimum": 6580, "maximum": 42875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24720.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19393.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13888.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13442.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13888.12, "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": 18054.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13888.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14582.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18748.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18748.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13888.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14582.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14582.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15276.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13888.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13888.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17696.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19443.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12776.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13888.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13888.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13888.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13888.12, "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": 13888.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12576, "minimum": 5678.4, "maximum": 32375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22385.48, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17486.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12576.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12120.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12576.11, "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": 16348.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12576.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13204.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16977.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16977.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12576.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13204.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13204.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13833.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12576.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12576.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13224.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17606.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5678.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12576.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12576.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12576.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12576.11, "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": 12576.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26437, "minimum": 6580, "maximum": 47059.195, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 47059.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37625.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26437.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26079.99 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 26437.75, "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": 34369.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 26437.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 27759.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 35690.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35690.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26437.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 27759.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 27759.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 29081.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 26437.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26437.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34006.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 37012.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14479.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26437.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 26437.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 26437.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26437.75, "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": 26437.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Allgrft implnt knee wscope", "code_information": [ { "code": "29867", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6599.85, "discounted_cash": 12796, "minimum": 1979.955, "maximum": 6599.85, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6599.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6599.85 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6599.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6599.85 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6599.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5308, "minimum": 2271.36, "maximum": 15750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9449.81, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6928.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4802.69 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5308.88, "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": 6901.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5574.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7166.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7166.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5574.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5574.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5839.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3793.48 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7432.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2271.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5308.88, "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": 5308.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13926, "minimum": 6580, "maximum": 50750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24789.65, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19449.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13481.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13926.77, "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": 18104.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13926.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14623.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18801.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18801.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14623.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14623.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15319.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13926.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13055.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19497.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13926.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13926.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13926.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13926.77, "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": 13926.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Thru Metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8542.82, "discounted_cash": 3261, "minimum": 2562.846, "maximum": 8542.82, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8542.82, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9907, "minimum": 5536.44, "maximum": 28875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17635.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13610.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9433.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9907.71, "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": 12880.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13375.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13375.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10403.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10403.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10898.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11541 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13870.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5536.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9907.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9907.71, "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": 9907.71, "additional_payer_notes": "100.00% 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": 16828, "minimum": 6580, "maximum": 50750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29954.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23665 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16828.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16403.25 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 16828.51, "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": 21877.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 16828.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17669.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 22718.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22718.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16828.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17669.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 17669.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18511.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16828.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16828.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17957.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 23559.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8233.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16828.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 16828.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 16828.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16828.51, "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": 16828.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35767, "minimum": 6580, "maximum": 91000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 63666.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51180.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35767.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 35475.61 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 35767.84, "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": 46498.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 35767.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 37556.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 48286.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 48286.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35767.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 37556.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 37556.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 39344.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 35767.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35767.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33987.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 50074.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19696.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35767.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 35767.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 35767.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35767.84, "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": 35767.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16970, "minimum": 6580, "maximum": 49000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 30208.29, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23871.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16971, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16546.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 16970.95, "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": 22062.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 16970.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17819.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 22910.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22910.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16971, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17819.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 17819.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18668.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16971, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16970.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22562.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 23759.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9688.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16971, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 16970.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 16970.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16970.95, "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": 16971, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20942, "minimum": 6580, "maximum": 61250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 37278.13, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29642.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20942.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20546.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 20942.77, "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": 27225.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 20942.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 21989.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 28272.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28272.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20942.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 21989.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 21989.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 23037.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20942.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20942.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17898.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 29319.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11427.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20942.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 20942.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 20942.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20942.77, "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": 20942.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8987, "minimum": 5004.09, "maximum": 25375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15997.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12272.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8506.88 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8987.23, "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": 11683.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9436.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12132.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12132.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9436.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9436.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9885.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7389.43 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12582.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5004.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8987.23, "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": 8987.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10448, "minimum": 5536.44, "maximum": 38500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18598.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14396.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9978.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10448.84, "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": 13583.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10448.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10971.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14105.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14105.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10971.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10971.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11493.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10448.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14394.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14628.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5536.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10448.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10448.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10448.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10448.84, "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": 10448.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5563, "minimum": 3442.53, "maximum": 16625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9903.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7299.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5059.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5563.69, "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": 7232.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5841.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7510.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7510.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5841.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5841.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6120.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5670.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7789.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3442.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5563.69, "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": 5563.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31267, "minimum": 6580, "maximum": 82250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 55655.38, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 44641.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31267.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 30943.22 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 31267.07, "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": 40647.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 31267.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 32830.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 42210.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42210.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31267.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 32830.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 32830.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 34393.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31267.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31267.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49541.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 43773.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 18170.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31267.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 31267.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 31267.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31267.07, "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": 31267.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25501, "minimum": 6580, "maximum": 87500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 45392.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36265.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25137.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 25501.52, "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": 33151.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 25501.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 26776.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 34427.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34427.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 26776.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 26776.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28051.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 25501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21087 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 35702.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13912.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 25501.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 25501.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25501.52, "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": 25501.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7820.65, "discounted_cash": 3261, "minimum": 898, "maximum": 7820.65, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17681, "minimum": 6580, "maximum": 44625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 31473.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24904.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17262.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 17681.71, "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": 22986.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 17681.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18565.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 23870.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23870.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18565.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 18565.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19449.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17681.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24979.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 24754.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10114.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 17681.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 17681.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17681.71, "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": 17681.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6771, "minimum": 3690.96, "maximum": 16625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12052.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9053.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6275.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6771.2, "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": 8802.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7109.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9141.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9141.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7109.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7109.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7448.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6338.21 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9479.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3690.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6771.2, "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": 6771.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29894 - ", "code_information": [ { "code": "29894", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8199.96, "discounted_cash": 3261, "minimum": 1123, "maximum": 8199.96, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8199.96, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% 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": 10691, "minimum": 5642.91, "maximum": 36750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19030.83, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14748.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10223.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10691.48, "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": 13898.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10691.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11226.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14433.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14433.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11226.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11226.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11760.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11870 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14968.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5642.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10691.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10691.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10691.48, "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": 10691.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24599.1, "discounted_cash": 3261, "minimum": 1123, "maximum": 24599.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10259.8, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8799.1, "discounted_cash": 3261, "minimum": 898, "maximum": 8799.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arthrodesis Triple", "code_information": [ { "code": "28715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13874.2, "discounted_cash": 12796, "minimum": 1403, "maximum": 13874.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13874.2 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12504.34 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10968.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13874.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12723.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery - 29897 - ", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9173.76, "discounted_cash": 3261, "minimum": 1123, "maximum": 9173.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 2324.8, "10th_percentile": 2324.8, "90th_percentile": 2324.8, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9173.76, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arthro/shoul surg; w/spacer", "code_information": [ { "code": "C9781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11386.48, "discounted_cash": 12796, "minimum": 3415.944, "maximum": 11386.48, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11386.48 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11386.48 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10968.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4158.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11386.48 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11386.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Amputation toe & metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9063.07, "discounted_cash": 3261, "minimum": 898, "maximum": 9063.07, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9063.07, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bacitracin Intramuscular For Soln 50000 Unit", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00009023301", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49769, "minimum": 6580, "maximum": 88590.1906, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 88590.19, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 71523.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49769.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 49575.9 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 49769.77, "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": 64700.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 49769.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 52258.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 67189.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 67189.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49769.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 52258.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 52258.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 54746.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 49769.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49769.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12959 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 69677.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 27540.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49769.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 49769.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 49769.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 49769.77, "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": 49769.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Aspirate Pleura W/ Imaging", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 625, "minimum": 527.06, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1250.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1000.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1156.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 700.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1000.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 844.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 600.85 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 656.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 656.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 687.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 527.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1966.97, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 875.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 611.39 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 625.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30768, "minimum": 5890.76, "maximum": 54767.3426, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 54767.34, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43917.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30768.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 30440.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 30768.17, "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": 39998.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 30768.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 32306.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 41537.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 41537.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30768.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 32306.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 32306.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 33845.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 30768.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30768.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5890.76 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 43075.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 16893.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30768.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 30768.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 30768.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30768.17, "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": 30768.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11232, "minimum": 6317.22, "maximum": 19994.0458, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19994.05, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15535.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11232.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10768.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11232.61, "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": 14602.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11232.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11794.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15164.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15164.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11232.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11794.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11794.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12355.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11232.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11232.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14994.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15725.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6317.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11232.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11232.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11232.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11232.61, "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": 11232.6, "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": 8733, "minimum": 3832.92, "maximum": 16625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15544.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11903.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8251 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8733.13, "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": 11353.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9169.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11789.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11789.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9169.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9169.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9606.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14447.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12226.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3832.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8733.13, "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": 8733.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11373, "minimum": 5075.07, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20245.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15739.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11373.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10910.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11373.61, "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": 14785.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11373.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11942.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15354.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15354.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11373.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11942.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11942.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12510.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11373.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11373.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22461.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15923.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5075.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11373.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11373.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11373.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11373.61, "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": 11373.6, "additional_payer_notes": "100.00% of Medicare 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": 16124, "minimum": 6580, "maximum": 42000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28701.06, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22641.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15693.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 16124.19, "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": 20961.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 16124.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16930.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 21767.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21767.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16930.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16930.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17736.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16124.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23268.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22573.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7843.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16124.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 16124.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 16124.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16124.19, "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": 16124.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12159.2, "discounted_cash": 3261, "minimum": 1627, "maximum": 12159.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1627 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10259.8, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39422, "minimum": 6580, "maximum": 116812.5, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 55191.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19413.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39422.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 39422.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 39422.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39422.57, "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": 39422.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 70172.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56490.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39422.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39156.02 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 39422.57, "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": 51249.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 39422.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 41393.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 53220.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53220.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39422.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 41393.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 41393.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 43364.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39422.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39422.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57540.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 } ] } ] }, { "description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13595.71, "discounted_cash": 7232, "minimum": 898, "maximum": 13595.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13595.71, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11571.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13379.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8099.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11571.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9763.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7955.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13595.71, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7064.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26061, "minimum": 6580, "maximum": 74375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 46389.04, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37078.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26061.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25700.84 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 26061.26, "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": 33879.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 26061.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 27364.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 35182.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35182.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26061.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 27364.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 27364.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28667.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 26061.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26061.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50090.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 36485.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12811.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26061.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 26061.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 26061.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26061.26, "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": 26061.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arthrt Elbw Expl Drg/Rmvl Fb", "code_information": [ { "code": "24000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8542.82, "discounted_cash": 3261, "minimum": 1403, "maximum": 8542.82, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8542.82, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Azithromycin Tab 250 Mg", "drug_information": { "unit": 30, "type": "EA" }, "code_information": [ { "code": "00069306030", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 16.6, "10th_percentile": 8.3, "90th_percentile": 87.18, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 87.18, "10th_percentile": 87.18, "90th_percentile": 87.18, "count": "1 through 10" } ] } ] }, { "description": "Arthrd Wrist With Autograft", "code_information": [ { "code": "25825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15839.2, "discounted_cash": 7232, "minimum": 1627, "maximum": 15839.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14464.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11571.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1627 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13379.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8099.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11571.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9763.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7955.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15839.2, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7064.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18141, "minimum": 6580, "maximum": 45500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32292.69, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25573.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18142, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17725.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 18141.96, "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": 23584.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 18141.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19049.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 24491.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24491.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18142, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19049.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19049.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19956.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18142, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18141.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17118.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25398.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10398.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18142, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 18141.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 18141.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18141.96, "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": 18142, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 2 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00003257016", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11805.5, "maximum": 35875, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16746.5 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25266, "minimum": 6580, "maximum": 70875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 44974.82, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 35924.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24900.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 25266.75, "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": 32846.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 25266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 26530.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 34110.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34110.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 26530.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 26530.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27793.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 25266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38364.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 35373.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14621.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25266.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 25266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 25266.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25266.75, "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": 25266.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 1 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00003256016", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14856, "minimum": 6580, "maximum": 28000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26444.68, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20800.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14417.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14856.56, "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": 19313.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14856.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15599.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 20056.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20056.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15599.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15599.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16342.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14856.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19139.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20799.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8446.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14856.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14856.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14856.56, "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": 14856.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Arthrt Elbw Jt Expl Bx Rmvl", "code_information": [ { "code": "24101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9280.75, "discounted_cash": 3261, "minimum": 1403, "maximum": 9280.75, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38525 - OR36038525", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8799.1, "discounted_cash": 3902, "minimum": 898, "maximum": 8799.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7805.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6244.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7219.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5463.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4341.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6244.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5268.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3721.4 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4292.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3264.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5463.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3786.69 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25730, "minimum": 6580, "maximum": 70000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 45800.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36598.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25730.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25367.84 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 25730.57, "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": 33449.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 25730.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 27017.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 34736.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34736.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25730.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 27017.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 27017.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28303.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 25730.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25730.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28339.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 36022.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15793.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25730.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 25730.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 25730.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25730.57, "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": 25730.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27290, "minimum": 6580, "maximum": 48576.6272, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 48576.63, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38864.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26938.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 27290.24, "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": 35477.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 27290.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 28654.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 36841.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 36841.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 28654.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 28654.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 30019.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27290.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28301.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 38206.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15793.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 27290.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 27290.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27290.24, "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": 27290.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ascorbic Acid Inj 500 Mg/Ml", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "67157010150", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15394, "minimum": 2626.26, "maximum": 27401.5158, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27401.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21581.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15394.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14958.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15394.11, "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": 20012.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15394.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16163.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 20782.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20782.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15394.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16163.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16163.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16933.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15394.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15394.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10543.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21551.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2626.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15394.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15394.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15394.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15394.11, "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": 15394.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9104, "minimum": 5855.85, "maximum": 23625, "payers_information": [ { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9559.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12291.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12291.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9559.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9559.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10015.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11090.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12746.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5855.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9104.62, "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": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16206.22, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12443.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9104.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8625.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9104.62, "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": 11836.01, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW HARVEST AUTOLOG", "code_information": [ { "code": "38232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7180.85, "discounted_cash": 4341, "minimum": 2154.255, "maximum": 7180.85, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7180.85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6945.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7180.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6077.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5312.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4558.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6945.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5860.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4553.18 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4558.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4558.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4775.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3994.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7180.85, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6077.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4633.06 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4341.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5707, "minimum": 2590.77, "maximum": 21875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10159.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7508.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5204.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5707.56, "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": 7419.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5992.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7705.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7705.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5992.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5992.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6278.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3346.02 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7990.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2590.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5707.56, "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": 5707.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bicarb 32 Meq/L-Dext Soln With K-Ca 2-3.5 Meq/L (Crrt)", "drug_information": { "unit": 5000, "type": "ML" }, "code_information": [ { "code": "24571010306", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5358, "minimum": 3300.57, "maximum": 16625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9537.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7000.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4852.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5358.27, "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": 6965.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5626.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7233.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7233.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5626.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5626.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5894.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4474.54 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7501.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3300.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5358.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5358.27, "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": 5358.27, "additional_payer_notes": "100.00% 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": 15862, "minimum": 6580, "maximum": 30625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28234.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22261.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15862.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15430.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15862.22, "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": 20620.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15862.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 21414, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21414, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15862.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16655.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16655.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17448.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15862.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15862.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27463.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22207.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7807.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15862.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15862.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15862.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15862.22, "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": 15862.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38500 - OR36038500", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8799.1, "discounted_cash": 3902, "minimum": 898, "maximum": 8799.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7805.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6244.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7219.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5463.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4341.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6244.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5268.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3721.4 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4292.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3264.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5463.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3786.69 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.25% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "00409174671", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "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": 40071, "minimum": 6580, "maximum": 71327.7684, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 71327.77, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 57433.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39809.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 40071.78, "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": 52093.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 40071.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 42075.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 54096.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 54096.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 42075.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 42075.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 44078.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40071.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58501.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 56100.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 23352.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 40071.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 40071.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 40071.78, "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": 40071.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6481, "minimum": 4776.85, "maximum": 24500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11536.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8632.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5983.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6481.31, "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": 8425.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6805.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8749.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8749.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6805.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6805.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7129.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4776.85 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9073.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5678.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6481.31, "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": 6481.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42982, "minimum": 6580, "maximum": 224437.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 76509.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 61662.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42982.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42741.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 42982.82, "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": 55877.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 42982.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 45131.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 58026.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 58026.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 42982.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 45131.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 45131.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 47281.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 42982.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42982.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43138.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 60175.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 21187.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42982.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 42982.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 42982.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 42982.82, "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": 42982.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine-Meloxicam Injection Er Soln 200-6 Mg/7Ml", "drug_information": { "unit": 7, "type": "ML" }, "code_information": [ { "code": "47426030301", "type": "NDC" }, { "code": "C9088", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 2031.34, "10th_percentile": 2031.34, "90th_percentile": 2031.34, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "additional_payer_notes": "185.00% of Medicare Rates", "median_amount": 298.48, "10th_percentile": 298.48, "90th_percentile": 298.48, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14347, "minimum": 6580, "maximum": 25978.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25538.82, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20060.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13904.95 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14347.65, "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": 18651.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14347.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15065.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 19369.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19369.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15065.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15065.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15782.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14347.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25978.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20086.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7027.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14347.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14347.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14347.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14347.65, "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": 14347.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Brain Canal Shunt Procedure", "code_information": [ { "code": "61070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.91, "discounted_cash": 703, "minimum": 212.073, "maximum": 706.91, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 706.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 590.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 706.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 684.82 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7491, "minimum": 4294.29, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13334.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10099.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7000.41 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7491.27, "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": 9738.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7865.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10113.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10113.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7865.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7865.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8240.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6282.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10487.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4294.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7491.27, "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": 7491.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5335, "minimum": 3194.1, "maximum": 20125, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9496.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6967.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4829.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5335.36, "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": 6935.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5602.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7202.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7202.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5602.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5602.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5868.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4060.58 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7469.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3194.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5335.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Azithromycin For Susp 200 Mg/5Ml", "drug_information": { "unit": 15, "type": "ML" }, "code_information": [ { "code": "59762312001", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 16.6, "10th_percentile": 8.3, "90th_percentile": 87.18, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 87.18, "10th_percentile": 87.18, "90th_percentile": 87.18, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5077, "minimum": 3123.12, "maximum": 11375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9038.27, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6592.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4569.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5077.68, "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": 6600.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5331.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6854.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6854.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5331.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5331.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5585.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6715.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7108.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3123.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5077.68, "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": 5077.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11719, "minimum": 6580, "maximum": 20860.4074, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20860.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16242.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11258.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11719.33, "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": 15235.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11719.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12305.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15821.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15821.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12305.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12305.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12891.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11719.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19799.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16407.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7665.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11719.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11719.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11719.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11719.33, "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": 11719.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5805, "minimum": 3194.1, "maximum": 21000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10334, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7650.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5302.93 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5805.62, "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": 7547.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7837.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7837.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6095.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6386.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4559.56 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8127.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3194.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5805.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5805.62, "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": 5805.62, "additional_payer_notes": "100.00% 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": 19000, "minimum": 6580, "maximum": 50750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33821.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26821.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18590.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 19000.88, "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": 24701.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19950.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 25651.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25651.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19950.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19950.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20900.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21875.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26601.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15047.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19000.88, "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": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7076, "minimum": 4471.74, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12595.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9496.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6582.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7076.12, "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": 9198.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7429.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9552.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9552.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7429.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7429.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7783.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7611.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9906.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4471.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7076.12, "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": 7076.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00409904601", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19000, "minimum": 6580, "maximum": 36750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33821.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26821.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18590.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 19000.88, "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": 24701.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19950.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 25651.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25651.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19950.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19950.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20900.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16727.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26601.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14337.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 19000.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19000.88, "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": 19000.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23029, "minimum": 6580, "maximum": 43750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 40993.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32674.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23030, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22648.26 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 23029.96, "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": 29938.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 23029.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24181.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 31090.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31090.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23030, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24181.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 24181.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25333, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23030, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23029.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26745 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32241.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12563.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23030, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 23029.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 23029.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23029.96, "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": 23030, "additional_payer_notes": "100.00% 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", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3797, "minimum": 2235.87, "maximum": 9625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 6758.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4732.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3280.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 3797.17, "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": 4936.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 3987.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 5126.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 5126.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 3987.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 3987.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4176.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4210.87 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 5316.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2235.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 3797.17, "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": 3797.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8915, "minimum": 4187.82, "maximum": 35000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15869.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12168.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8434.8 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8915.65, "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": 11590.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9361.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12036.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12036.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9361.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9361.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9807.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12036.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12481.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4187.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8915.65, "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": 8915.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15013, "minimum": 6580, "maximum": 26723.7096, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26723.71, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21027.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15013.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14575.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15013.32, "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": 19517.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15013.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15763.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 20267.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20267.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15013.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15763.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15763.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16514.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15013.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15013.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16755.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21018.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8091.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15013.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15013.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15013.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15013.32, "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": 15013.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4591, "minimum": 2519.79, "maximum": 16625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8173.19, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5886.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4080.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 4591.68, "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": 5969.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 4821.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6198.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6198.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 4821.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 4821.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5050.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3873.35 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6428.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2519.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4591.68, "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": 4591.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9157, "minimum": 6423.69, "maximum": 30625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16300.49, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12520.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8678.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9157.58, "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": 11904.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9615.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12362.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12362.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9615.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9615.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10073.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8237.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12820.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6423.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9157.58, "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": 9157.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14071, "minimum": 6580, "maximum": 28000, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25047.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19659.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13626.72 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14071.36, "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": 18292.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14071.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14774.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18996.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18996.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14774.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14774.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15478.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14071.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23825 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19699.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7559.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14071.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14071.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14071.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14071.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51577, "minimum": 6580, "maximum": 91807.238, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 91807.24, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 74149.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 51395.92 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 51577.1, "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": 67050.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 54155.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 69629.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 69629.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 54155.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 54155.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 56734.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55927.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 72207.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 28533.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 51577.1, "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": 51577.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11818, "minimum": 6580, "maximum": 48562.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21037.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16386.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11358.37 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11818.83, "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": 15364.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11818.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12409.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15955.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15955.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12409.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12409.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13000.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14274.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16546.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7736.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11818.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11818.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11818.83, "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": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19579, "minimum": 6580, "maximum": 34851.0294, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 34851.03, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27661.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 19173.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 19579.23, "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": 25453, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 19579.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 20558.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 26431.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26431.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 20558.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 20558.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21537.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19579.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20408.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 27410.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11250.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19579.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 19579.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 19579.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19579.23, "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": 19579.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17650, "minimum": 6580, "maximum": 31417.3916, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 31417.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24858.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17230.72 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 17650.22, "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": 22945.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 17650.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18532.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 23827.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23827.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18532.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 18532.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19415.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23610.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 24710.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9724.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17650.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 17650.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 17650.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17650.22, "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": 17650.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33597, "minimum": 6580, "maximum": 59803.7636, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 59803.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 48027.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33290.15 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 33597.62, "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": 43676.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 33597.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 35277.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 45356.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 45356.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 35277.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 35277.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 36957.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 33597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33597.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46013 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 47036.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 18241.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33597.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 33597.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 33597.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33597.62, "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": 33597.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43533, "minimum": 6580, "maximum": 77489.185, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 77489.19, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 62462.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 43295.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 43533.25, "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": 56593.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 43533.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 45709.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 58769.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 58769.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 45709.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 45709.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 47886.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43533.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32356.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 60946.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 24062.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43533.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 43533.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 43533.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43533.25, "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": 43533.3, "additional_payer_notes": "100.00% 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": 11904, "minimum": 5713.89, "maximum": 30625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21189.12, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16510.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11444.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11904, "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": 15475.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16070.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16070.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12499.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12499.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13094.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17802.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16665.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5713.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11904, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11904, "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": 11904, "additional_payer_notes": "100.00% 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": 23822, "minimum": 6580, "maximum": 56000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 42403.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33825.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23822.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23446.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 23822.32, "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": 30969.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 23822.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 25013.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 32160.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32160.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23822.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 25013.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 25013.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 26204.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23822.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23822.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50742.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 33351.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13024.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23822.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 23822.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 23822.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23822.32, "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": 23822.3, "additional_payer_notes": "100.00% 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": 38710, "minimum": 6580, "maximum": 68904.4764, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 68904.48, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 55455.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38710.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 38438.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 38710.38, "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": 50323.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 38710.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 40645.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 52259.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 52259.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38710.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 40645.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 40645.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 42581.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38710.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38710.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45015.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 54194.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 23849.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38710.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 38710.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 38710.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 38710.38, "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": 38710.4, "additional_payer_notes": "100.00% 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": 13845, "minimum": 6580, "maximum": 28875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24644.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19330.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13398.95 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13845.18, "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": 17998.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13845.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14537.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18690.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18690.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", 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"case rate", "standard_charge_dollar": 13845.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14383.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19383.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7878.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13845.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13845.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13845.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13845.18, "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": 13845.2, "additional_payer_notes": "100.00% 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": 12206, "minimum": 6530.16, "maximum": 21726.7868, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21726.79, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16949.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11748.32 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12206.06, "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": 15867.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12206.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12816.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16478.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16478.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12816.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12816.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13426.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12206.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14469.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17088.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6530.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12206.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12206.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12206.06, "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": 12206.1, "additional_payer_notes": "100.00% 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": 36616, "minimum": 6580, "maximum": 65176.5334, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 65176.53, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 52413.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36616, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 36329.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 36616.03, "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": 47600.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 36616.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 38446.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 49431.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 49431.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36616, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 38446.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 38446.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 40277.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36616, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36616.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37474.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 51262.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20193.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36616, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 36616.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 36616.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 36616.03, "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": 36616, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9537.22, "discounted_cash": 3902, "minimum": 898, "maximum": 9537.22, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7805.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6244.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7219.68, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5463.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4341.64 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6244.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5268.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3721.4 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4097.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4292.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3264.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9537.22, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5463.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3786.69 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3902.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cefotetan Disodium For Inj 2 Gm", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "63323038620", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "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": 70562, "minimum": 6580, "maximum": 125600.7694, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 125600.77, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 101731.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 70562.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 70514.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 70562.23, "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": 91730.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 70562.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 74090.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 95259.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 95259.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 70562.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 74090.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 74090.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 77618.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 70562.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 70562.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 98572.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 98787.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 39180.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 70562.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 70562.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 70562.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 70562.23, "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": 70562.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28245, "minimum": 6580, "maximum": 50276.2424, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 50276.24, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40251.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 27900.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 28245.08, "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": 36718.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 28245.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 29657.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 38130.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 38130.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 29657.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 29657.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 31069.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 28245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37071.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 39543.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15722.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 28245.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 28245.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28245.08, "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": 28245.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47603, "minimum": 6580, "maximum": 84734.853, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 84734.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 68376.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 47394.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 47603.85, "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": 61885.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 49983.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 64265.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 64265.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 49984.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 49983.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 52364.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56715 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 66645.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 35525.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 47603.85, "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": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Blepharp Upr Eyelid Xcsv Skn", "code_information": [ { "code": "15823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8772.09, "discounted_cash": 2056, "minimum": 1559.38, "maximum": 8772.09, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4112.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1627 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3804.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2776.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2262.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6469.69, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8140.69, "discounted_cash": 1946, "minimum": 898, "maximum": 8140.69, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3892.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3114.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3600.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2724.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2214.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2043.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3114.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2627.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1897.76 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2043.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2043.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2140.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1664.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6123.03, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2724.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1931.05 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1946.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5213.77, "discounted_cash": 2895, "minimum": 898, "maximum": 5213.77, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35102, "minimum": 6580, "maximum": 62481.8626, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 62481.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 50213.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 34805.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 35102.17, "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": 45632.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 35102.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 36857.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 47387.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47387.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 36857.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 36857.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38612.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 35102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35102.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37833.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 49143.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 35102.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 35102.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35102.17, "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": 35102.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9818, "minimum": 6580, "maximum": 34125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17476.47, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13480.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9343.73 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9818.24, "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": 12763.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10309.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13254.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13254.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10309.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10309.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10800.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12450.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13745.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8872.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9818.24, "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": 9818.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6773, "minimum": 4471.74, "maximum": 28000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12056.56, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9056.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6277.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6773.35, "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": 8805.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7112.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9144.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9144.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7112.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7112.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7450.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4905.67 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9482.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4471.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6773.35, "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": 6773.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Change Of Bladder Tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7820.65, "discounted_cash": 249, "minimum": 207.33, "maximum": 7820.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 498.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 398.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 460.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.75 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 261.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 398.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 236.36 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 261.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 261.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 273.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 783.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 348.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.5 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 249.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bronch Ebus Samplng 3/> Node", "code_information": [ { "code": "31653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14079.2, "discounted_cash": 3716, "minimum": 1346.54, "maximum": 18375.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7432.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5945.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6874.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5202.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4180.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5945.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5016.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3583.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4087.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3143.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11690.72, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5202.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1346.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3645.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18013, "minimum": 6580, "maximum": 32064.6174, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32064.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25387.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18013.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17596.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 18013.83, "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": 23417.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 18013.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18914.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 24318.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24318.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18013.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18914.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 18914.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19815.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18013.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18013.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20234.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25219.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11285.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18013.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 18013.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 18013.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18013.83, "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": 18013.8, "additional_payer_notes": "100.00% 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": 34927, "minimum": 6580, "maximum": 150937.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 62170.99, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 49959.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34927.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 34629.39 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 34927.52, "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": 45405.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 34927.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 36673.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 47152.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47152.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34927.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 36673.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 36673.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38420.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 34927.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34927.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43696.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 48898.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9085.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34927.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 34927.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 34927.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34927.52, "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": 34927.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "00409904517", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8127, "minimum": 4897.62, "maximum": 20935.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14467.11, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11023.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7641.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8127.59, "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": 10565.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8533.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10972.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10972.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8533.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8533.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8940.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7887.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11378.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4897.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8127.59, "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": 8127.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6619, "minimum": 2839.2, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11782.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8832.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6122.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6619.46, "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": 8605.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6950.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8936.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8936.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6950.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6950.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7281.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6259.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9267.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2839.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6619.46, "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": 6619.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine-Meloxicam Injection Er Soln 400-12 Mg/14Ml", "drug_information": { "unit": 14, "type": "ML" }, "code_information": [ { "code": "47426030102", "type": "NDC" }, { "code": "C9088", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 2031.34, "10th_percentile": 2031.34, "90th_percentile": 2031.34, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "additional_payer_notes": "185.00% of Medicare Rates", "median_amount": 298.48, "10th_percentile": 298.48, "90th_percentile": 298.48, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8533, "minimum": 4187.82, "maximum": 22204, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15189.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11613.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8049.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8533.43, "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": 11093.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8960.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11520.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11520.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8960.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8960.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9386.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11675 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11946.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4187.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8533.43, "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": 8533.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 309630, "minimum": 6580, "maximum": 551141.5424, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 551141.54, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 449057.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 309630, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 311261.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 309630.08, "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": 402519.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 309630.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 325111.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 418000.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 418000.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 309630, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 325111.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 325111.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 340593, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 309630, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 309630.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 311950 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 433482.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 154275.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 309630, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 309630.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 309630.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 309630.08, "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": 309630, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9903, "minimum": 5217.03, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17628.09, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13603.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9429.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9903.42, "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": 12874.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10398.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13369.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13369.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10398.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10398.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10893.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7761.31 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13864.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5217.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9903.42, "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": 9903.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47603, "minimum": 6580, "maximum": 84734.853, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 84734.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 68376.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 47394.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 47603.85, "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": 61885.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 49983.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 64265.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 64265.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 49984.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 49983.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 52364.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45107 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 66645.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 37299.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 47603.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 47603.85, "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": 47603.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24183, "minimum": 6580, "maximum": 68250, "payers_information": [ { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 24183.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 25392.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 32648.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32648.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 25392.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 25392.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 26602.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 24183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24183.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26086.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 33857.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11889.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 24183.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 24183.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24183.79, "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": 24183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 43047.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34351.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24183.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23810.19 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 24183.79, "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": 31438.93, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21627, "minimum": 6580, "maximum": 38496.149, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 38496.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30636.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21235.49 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 21627.05, "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": 28115.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 21627.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 22708.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 29196.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29196.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 22708.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 22708.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 23789.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 21627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21627.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23681.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 30277.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11853.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21627, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 21627.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 21627.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21627.05, "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": 21627, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55498, "minimum": 6580, "maximum": 98787.8818, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 98787.88, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 79846.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55498.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 55345.19 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 55498.81, "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": 72148.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 55498.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 58273.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 74923.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 74923.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55498.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 58273.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 58273.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 61048.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 55498.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55498.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65330.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 77698.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 30734.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55498.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 55498.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 55498.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 55498.81, "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": 55498.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16378, "minimum": 6580, "maximum": 45500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29153.36, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23010.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16378.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15949.86 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 16378.29, "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": 21291.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 16378.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17197.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 22110.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22110.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16378.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17197.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 17197.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18016.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16378.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16378.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17506.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22929.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9404.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16378.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 16378.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 16378.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16378.29, "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": 16378.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18112, "minimum": 5146.05, "maximum": 32240.4458, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32240.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25530.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18112.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17696.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 18112.61, "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": 23546.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 18112.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 24452.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24452.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18112.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19018.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19018.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19923.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18112.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18112.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12501.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5146.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18112.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 18112.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 18112.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18112.61, "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": 18112.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15588, "minimum": 6580, "maximum": 43750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27748.06, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21863.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15154.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15588.8, "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": 20265.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16368.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 21044.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21044.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16368.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16368.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17147.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20320.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21824.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7559.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15588.8, "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": 15588.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14445, "minimum": 6580, "maximum": 25713.3638, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25713.36, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20203.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14445.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14003.7 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14445.71, "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": 18779.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14445.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15167.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 19501.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19501.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14445.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15168, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15167.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15890.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14445.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14445.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19329.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20223.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7914.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14445.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14445.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14445.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14445.71, "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": 14445.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8099, "minimum": 5146.05, "maximum": 28875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14417.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10983.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7613.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8099.67, "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": 10529.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8504.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10934.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10934.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8504.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8504.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8909.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8668.24 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11339.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5146.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8099.67, "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": 8099.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7395, "minimum": 4649.19, "maximum": 17128.8, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13163.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9960.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6903.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7395.35, "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": 9613.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7765.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9983.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9983.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7765.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7765.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8134.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6544.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10353.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4649.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7395.35, "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": 7395.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12425, "minimum": 5962.32, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22116.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17267.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11968.88 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12425.08, "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": 16152.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12425.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13046.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16773.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16773.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13046.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13046.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13667.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12425.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15849 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17395.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5962.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12425.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12425.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12425.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12425.08, "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": 12425.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15480, "minimum": 6580, "maximum": 72187.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27555.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21706.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15480.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15045.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15480.71, "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": 20124.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15480.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16254.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 20898.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20898.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15480.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16254.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16254.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17028.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15480.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15480.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13354 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21672.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8659.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15480.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15480.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15480.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15480.71, "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": 15480.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6573, "minimum": 3619.98, "maximum": 25375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11701.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8766.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6076.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6573.65, "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": 8545.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6902.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8874.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8874.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6902.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6902.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7231.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6899.89 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9203.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3619.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6573.65, "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": 6573.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10874, "minimum": 6580, "maximum": 57750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19357, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15015.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10874.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10407.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10874.72, "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": 14137.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10874.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11418.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14680.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14680.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10874.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11418.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11418.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11962.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10874.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10874.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8833.14 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15224.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8233.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10874.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10874.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10874.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10874.72, "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": 10874.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin Hcl Ophth Oint 0.3%", "drug_information": { "unit": 4, "type": "GR" }, "code_information": [ { "code": "00065065435", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19096, "minimum": 6580, "maximum": 51625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33991.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26959.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19096.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18686.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 19096.08, "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": 24824.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 19096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 20050.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 25779.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25779.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19096.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 20050.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 20050.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21005.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 19096.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13392.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26734.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8695.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19096.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 19096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 19096.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19096.08, "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": 19096.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14627, "minimum": 6580, "maximum": 41125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26036.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20467.31 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14627.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14186.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14627.51, "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": 19015.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14627.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15358.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 19747.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19747.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14627.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15358.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15358.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16090.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14627.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14627.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17013.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20478.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7701.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14627.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14627.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14627.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14627.51, "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": 14627.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cmplx rpr enel 2.6-7.5 cm", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3164.13, "discounted_cash": 736, "minimum": 521.83, "maximum": 3164.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1362.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 694.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 994.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 594.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 810.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 521.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2317.44, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 605.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26039, "minimum": 6580, "maximum": 70000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 46350.81, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37047.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26039.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 25679.22 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 26039.78, "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": 33851.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 26039.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 27341.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 35153.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35153.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26039.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 27341.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 27341.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28643.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 26039.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26039.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33401.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 36455.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12811.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26039.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 26039.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 26039.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26039.78, "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": 26039.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10712, "minimum": 6580, "maximum": 40250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19069.07, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14780.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10713, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10244.73 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10712.96, "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": 13926.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10712.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11248.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14462.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14462.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10713, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11248.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11248.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10713, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10712.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10900.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14998.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7843.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10713, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10712.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10712.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10712.96, "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": 10713, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11457, "minimum": 6580, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20394.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15861.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10994.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11457.36, "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": 14894.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12030.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15467.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15467.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12030.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12030.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12603.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10744.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16040.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7559.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11457.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11457.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11457.36, "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": 11457.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8468, "minimum": 5678.4, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15073.57, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11518.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7984.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8468.3, "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": 11008.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8891.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11432.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11432.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8891.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8891.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9315.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7755.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11855.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5678.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8468.3, "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": 8468.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CMBN ANT PST COLPRHY", "code_information": [ { "code": "57260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30969.35, "discounted_cash": 4985, "minimum": 1627, "maximum": 30969.35, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9971.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7977.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1627 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9224.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6980.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5596.95 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5235.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7977.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6731.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4797.38 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5235.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5235.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5484.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4208.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15685.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6980.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4881.55 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4985.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12346, "minimum": 4400.76, "maximum": 27279.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21976.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17153.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12346.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11889.6 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12346.35, "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": 16050.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12346.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12963.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16667.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16667.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12346.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12963.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12963.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13581.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12346.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12346.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17284.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4400.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12346.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12346.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12346.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12346.35, "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": 12346.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5134, "minimum": 2768.22, "maximum": 21000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9140.21, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6676.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4627.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5134.95, "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": 6675.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5391.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6932.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6932.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5391.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5391.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5648.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4300.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7188.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2768.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5134.95, "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": 5134.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7402, "minimum": 4010.37, "maximum": 19032, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13176.47, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9970.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6911.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7402.51, "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": 9623.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7772.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9993.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9993.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7772.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7772.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8142.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8532.54 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4010.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7402.51, "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": 7402.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55261, "minimum": 6580, "maximum": 99750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 98366.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 79502.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55261.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 55106.6 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 55261.89, "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": 71840.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 55261.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 58025, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 74603.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 74603.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55261.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 58024.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 58025, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 60788.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 55261.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55261.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67397.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 77366.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 27114.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55261.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 55261.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 55261.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 55261.89, "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": 55261.9, "additional_payer_notes": "100.00% 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": 8199, "minimum": 5607.42, "maximum": 19250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14594.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11127.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7713.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8199.17, "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": 10658.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8609.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11068.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11068.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8609.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8609.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9019.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10410 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11478.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5607.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8199.17, "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": 8199.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5693, "minimum": 3513.51, "maximum": 14875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10133.99, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7487.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5189.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5693.25, "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": 7401.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5977.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7685.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7685.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5977.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5977.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6262.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5628.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7970.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3513.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5693.25, "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": 5693.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43934, "minimum": 6580, "maximum": 78202.6624, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 78202.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 63044.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43934.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 43699.22 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 43934.08, "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": 57114.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 43934.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 46130.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 59311.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 59311.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43934.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 46130.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 46130.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 48327.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43934.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43934.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58235.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 61507.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 24275.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43934.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 43934.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 43934.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43934.08, "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": 43934.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5639, "minimum": 3371.55, "maximum": 19250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10038.43, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7409.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5135.7 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5639.57, "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": 7331.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5921.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7613.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7613.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5921.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5921.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6203.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5709.55 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7895.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3371.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5639.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5639.57, "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": 5639.57, "additional_payer_notes": "100.00% 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": 15332, "minimum": 6580, "maximum": 42875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27291.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21491.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15332.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14896.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15332.55, "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": 19932.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15332.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16099.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 20698.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20698.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15332.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16099.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16099.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16865.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15332.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15332.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19282.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21465.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7417.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15332.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15332.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15332.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15332.55, "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": 15332.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42545, "minimum": 6580, "maximum": 75730.9722, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 75730.97, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 61027.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42300.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 42545.49, "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": 55309.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 42545.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 44672.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 57436.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 57436.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 42545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 44672.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 44672.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 46800.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 42545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42545.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51937.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 59563.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 16609.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 42545.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 42545.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 42545.49, "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": 42545.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00074438010", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6270, "minimum": 4116.84, "maximum": 21000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11160.88, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8325.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5770.72 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6270.16, "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": 8151.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6583.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8464.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8464.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6583.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6583.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6897.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5092.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8778.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4116.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6270.16, "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": 6270.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10297, "minimum": 4897.62, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18330.1, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14176.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9826.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10297.81, "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": 13387.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10297.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10812.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13902.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13902.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10812.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10812.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11327.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10297.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19512.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14416.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4897.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10297.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10297.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10297.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10297.81, "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": 10297.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30521, "minimum": 6580, "maximum": 54329.071, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 54329.07, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43559.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30522, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 30192.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 30521.95, "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": 39678.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 30521.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 32048.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 41204.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 41204.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30522, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 32048.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 32048.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 33574.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 30522, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30521.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41976.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 42730.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15828.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30522, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 30521.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 30521.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30521.95, "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": 30522, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13644, "minimum": 6210.75, "maximum": 37625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24286.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19038.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13644, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13196.41 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13644.04, "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": 17737.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13644.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14326.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18419.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18419.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13644, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14326.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14326.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15008.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13644, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13644.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12246.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19101.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6210.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13644, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13644.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13644.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13644.04, "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": 13644, "additional_payer_notes": "100.00% 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": 31514, "minimum": 6580, "maximum": 56094.9378, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 56094.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 45000.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 31191.9 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 31514.01, "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": 40968.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 31514.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 33089.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 42543.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42543.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 33089.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 33089.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 34665.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31514.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45423.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 44119.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13699.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31514, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 31514.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 31514.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31514.01, "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": 31514, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 78373, "minimum": 6580, "maximum": 139504.741, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 139504.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 113079.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 78373.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 78380.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 78373.45, "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": 101885.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 78373.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 82292.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 105804.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 105804.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 78373.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 82292.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 82292.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 86210.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 78373.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 78373.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 103852 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 109722.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 43546.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 78373.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 78373.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 78373.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 78373.45, "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": 78373.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Correction Eyelid W/Implant", "code_information": [ { "code": "67912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8542.82, "discounted_cash": 2369, "minimum": 1123, "maximum": 8542.82, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4739.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3791.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4383.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3317.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2645.1 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2488.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3791.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3199.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.23 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2488.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2488.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2606.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1988.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7454.92, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3317.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2307.01 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Colonoscopy W/Lesion Removal", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 1192, "minimum": 898, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2385.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1908.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2206.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1336.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1252.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1908.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1610.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1145.87 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1252.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1252.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1311.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1005.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3752.23, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1669.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1165.97 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1192.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39640, "minimum": 6580, "maximum": 70875, "payers_information": [ { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 41622.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 43604.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39640.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55279 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 55496.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22642.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 39640.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 39640.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39640.17, "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": 39640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 70559.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56806.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 39375.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 39640.17, "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": 51532.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 39640.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 41622.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 53514.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53514.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39640.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 41622.18, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8295, "minimum": 5571.93, "maximum": 28000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14765.24, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11267.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7809.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8295.08, "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": 10783.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8709.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11198.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11198.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8709.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8709.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9124.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8622.72 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11613.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5571.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8295.08, "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": 8295.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23518, "minimum": 6580, "maximum": 41863.5174, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41863.52, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33384.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23518.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23140.56 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 23518.83, "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": 30574.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 23518.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24694.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 31750.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31750.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23518.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24694.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 24694.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25870.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23518.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23518.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27284.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32926.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23518.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 23518.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 23518.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23518.83, "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": 23518.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Create tear duct drain", "code_information": [ { "code": "68750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2643.39, "discounted_cash": 3918, "minimum": 793.017, "maximum": 2643.39, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2643.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2643.39 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2643.39 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2643.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2643.39 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2643.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5467, "minimum": 2342.34, "maximum": 18375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9731.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7158.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4961.99 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5467.06, "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": 7107.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5740.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7380.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7380.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5740.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5740.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6013.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5162.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7653.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2342.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5467.06, "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": 5467.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Corrj Halux Rigdus W/Implt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7820.65, "discounted_cash": 7232, "minimum": 2346.195, "maximum": 7820.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7820.65 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7820.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3529.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7064.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Closure of eyelid by suture", "code_information": [ { "code": "67875", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2894.56, "discounted_cash": 993, "minimum": 825.66, "maximum": 2894.56, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1987.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1589.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1838.14, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1391.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1098.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1043.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1589.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1341.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 941.25 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1043.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1043.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1092.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 825.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2894.56, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1391.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 957.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 993.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8403, "minimum": 5536.44, "maximum": 23625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14957.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11424.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7918.71 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8403.16, "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": 10924.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8823.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11344.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11344.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8823.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8823.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9243.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13064.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11764.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5536.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8403.16, "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": 8403.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12022, "minimum": 6580, "maximum": 32375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21400.62, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16683.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12022.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11563.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12022.82, "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": 15629.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12022.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12623.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16230.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16230.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12022.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12623.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12623.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13225.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12022.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12022.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12923.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16831.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8091.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12022.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12022.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12022.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12022.82, "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": 12022.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cltx Sho Dslc W/Mnpj W/Anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6649.25, "discounted_cash": 1602, "minimum": 702, "maximum": 6649.25, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2964.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1814.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2163.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1555.32 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1762.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1364.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5042.06, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1582.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10215, "minimum": 6580, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18183.59, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14057.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9743.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10215.5, "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": 13280.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10726.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13790.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13790.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10726.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10726.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11237.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13448.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14301.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6814.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10215.5, "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": 10215.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33083, "minimum": 6580, "maximum": 58888.986, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 58888.99, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47281.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 32772.61 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 33083.7, "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": 43008.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 34737.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 44663, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44663, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 34737.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 34737.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 36392.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36692.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 46317.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19661.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33083.7, "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": 33083.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18303, "minimum": 6580, "maximum": 48125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32579.34, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25807.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17888.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 18303, "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": 23793.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19218.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 24709.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24709.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19218.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19218.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20133.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20817.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25624.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 16999.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 18303, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18303, "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": 18303, "additional_payer_notes": "100.00% 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": 28539, "minimum": 6580, "maximum": 50801.1466, "payers_information": [ { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 38528.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28540, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 29966.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 29967, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 31394, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 28540, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33479.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 39955.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15899.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28540, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 28539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 28539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28539.97, "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": 28540, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 50801.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40679.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28540, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28196.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 28539.97, "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": 37101.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 28539.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 29967, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 38528.96, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6524, "minimum": 2413.32, "maximum": 21875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11614.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8695.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6027.33 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6524.98, "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": 8482.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6851.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8808.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8808.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6851.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6851.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7177.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6940.26 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9134.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2413.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6524.98, "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": 6524.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2543.18, "discounted_cash": 3261, "minimum": 762.954, "maximum": 2543.18, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2543.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2543.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2543.18 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2543.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2543.18 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2543.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14584, "minimum": 6580, "maximum": 42875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25960.53, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20404.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14143.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14584.57, "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": 18959.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14584.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15313.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 19689.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19689.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15313.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15313.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16043.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14584.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12856.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20418.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10114.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14584.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14584.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14584.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14584.57, "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": 14584.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cysto W/Irrg&Evac Mlt Clots", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8542.82, "discounted_cash": 3513, "minimum": 2488, "maximum": 8542.82, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7026.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6499.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3910.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4743.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3351.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3864.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2940.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8542.82, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3410.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs prx mtar osteot", "code_information": [ { "code": "28295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10016.49, "discounted_cash": 3261, "minimum": 1648.32, "maximum": 10016.49, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10016.49, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1648.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7713, "minimum": 3407.04, "maximum": 25375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13730.69, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10422.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7224.58 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7713.87, "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": 10028.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8099.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10413.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10413.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8099.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8099.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8485.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7093.13 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10799.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3407.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7713.87, "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": 7713.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURETERO WSTONE REMOVE", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4097.99, "discounted_cash": 3513, "minimum": 1229.397, "maximum": 4097.99, 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"Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4097.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3910.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4097.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4097.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3351.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3864.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2940.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4097.99, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4097.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3410.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23093, "minimum": 6580, "maximum": 41106.7326, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41106.73, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32767.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22712.41 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 23093.67, "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": 30021.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 23093.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24248.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 31176.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31176.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24248.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 24248.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25403.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23093.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34240.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 32331.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13060.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23093.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 23093.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 23093.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23093.67, "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": 23093.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6431, "minimum": 4152.33, "maximum": 16625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11448.84, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8560.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5933.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6431.93, "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": 8361.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6753.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8683.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8683.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6753.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6753.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7075.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10702.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9004.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6431.93, "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": 6431.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURETERO & OR PYELOSCOPE", "code_information": [ { "code": "52351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2457.23, "discounted_cash": 3513, "minimum": 737.169, "maximum": 2457.23, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2457.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2457.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2457.23 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2457.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2457.23 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2457.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Conivaptan Hcl Iv Soln 20 Mg/100Ml In Dextrose 5%", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "66220016010", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6888.7, "maximum": 22750, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7529.42 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15206, "minimum": 6580, "maximum": 38500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27067.69, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21308.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15206.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14769.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15206.57, "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": 19768.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15206.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15966.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 20528.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20528.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15206.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15966.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15966.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16727.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15206.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15206.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13092.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21289.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7665.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15206.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15206.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15206.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15206.57, "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": 15206.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONIZATION OF CERVIX", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9656.07, "discounted_cash": 3226, "minimum": 898, "maximum": 9656.07, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6452.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5162.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5968.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4517.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3604.95 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3387.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5162.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4355.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3089.96 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3387.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3387.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3549.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2710.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9656.07, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4517.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3226.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3144.17 } ] } ] }, { "description": "Dantrolene Sodium For Iv Soln 20 Mg", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "42023012306", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8795, "minimum": 6580, "maximum": 30625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15655.81, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11994.21 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8313.71 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8795.4, "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": 11434.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9235.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11873.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11873.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9235.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9235.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9674.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10793.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12313.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7914.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8795.4, "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": 8795.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Delay flap eyenosearlip", "code_information": [ { "code": "15630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2530.95, "discounted_cash": 2056, "minimum": 759.285, "maximum": 2530.95, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2530.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2262.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2530.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CPTRASST DIR MS PX", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25880.83, "minimum": 1662, "maximum": 25880.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9813, "minimum": 6580, "maximum": 34125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17467.55, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13472.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9338.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9813.23, "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": 12757.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10303.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13247.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13247.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10303.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10303.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10794.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13877.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13738.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8695.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9813.23, "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": 9813.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14079.2, "discounted_cash": 7232, "minimum": 1627, "maximum": 14079.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14079.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11571.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1627 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13379.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8099.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11571.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9763.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7955.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14079.2, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7064.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7051, "minimum": 2945.67, "maximum": 24500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12552.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9461.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6557.84 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7051.78, "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": 9167.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7404.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9519.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9519.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7404.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7404.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7756.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7048.47 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9872.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2945.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7051.78, "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": 7051.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18597, "minimum": 6580, "maximum": 33104.262, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 33104.26, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26235.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 18185.06 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 18597.9, "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": 24177.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19527.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 25107.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25107.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19527.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19527.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20457.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24352.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 26037.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10256.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18597.9, "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": 18597.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7274, "minimum": 2058.42, "maximum": 12948.4142, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12948.41, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9784.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6782.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7274.39, "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": 9456.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7638.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9820.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9820.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7638.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7638.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8001.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3940.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10184.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2058.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7274.39, "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": 7274.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs jt arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11732.85, "discounted_cash": 12796, "minimum": 1123, "maximum": 11732.85, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11732.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11732.85 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10968.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11732.85 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11732.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Destruct B9 Lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8326.23, "discounted_cash": 199, "minimum": 169.39, "maximum": 8326.23, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 399.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 319.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 369.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 225.29 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 319.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.1 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 209.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 209.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 219.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 629.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48719, "minimum": 6580, "maximum": 86719.8556, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 86719.86, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 69996.71 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48719, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 48517.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 48719.02, "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": 63334.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 48719.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 51154.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 65770.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 65770.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48719, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 51154.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 51154.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 53590.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 48719, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48719.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 85968.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 68206.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13770.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48719, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 48719.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 48719.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 48719.02, "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": 48719, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6525.05, "discounted_cash": 7232, "minimum": 1123, "maximum": 6525.05, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6525.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6525.05 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6525.05 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6525.05, "additional_payer_notes": "100.00% 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": 41555, "minimum": 6580, "maximum": 73968.9146, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 73968.91, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 59589.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41555.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 41304 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 41555.57, "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": 54022.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 41555.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 43633.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 56100.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 56100.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41555.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 43633.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 43633.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 45711.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41555.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41555.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54360.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 58177.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22252.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41555.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 41555.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 41555.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 41555.57, "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": 41555.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs rsc prx phlx bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7039.42, "discounted_cash": 3261, "minimum": 898, "maximum": 7039.42, "payers_information": [ { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7039.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl Iv Soln 200 Mcg/2Ml", "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", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Create tear sac drain", "code_information": [ { "code": "68720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4196.7, "discounted_cash": 3918, "minimum": 1259.01, "maximum": 4196.7, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4196.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4114.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3664.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4114.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4114.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4196.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3729.06 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60878, "minimum": 6580, "maximum": 108363.819, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 108363.82, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 87662.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 60878.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 60762.72 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 60878.55, "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": 79142.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 60878.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 63922.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 82186.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 82186.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 60878.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 63922.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 63922.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 66966.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 60878.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60878.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50880.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 85229.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 33750.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 60878.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 60878.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 60878.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 60878.55, "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": 60878.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7518.74, "discounted_cash": 3513, "minimum": 898, "maximum": 7518.74, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7026.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6499.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3910.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4743.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3351.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3864.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2940.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7518.74, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3410.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Corrj halux rigdus wo implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9063.07, "discounted_cash": 3261, "minimum": 1123, "maximum": 9063.07, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9063.07, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 10%", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "00264752020", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8681, "minimum": 3735.94, "maximum": 19250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15453.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11828.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8199.1 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8681.6, "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": 11286.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9115.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11720.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11720.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9115.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9115.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9549.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3735.94 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12154.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4258.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8681.6, "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": 8681.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7917, "minimum": 5217.03, "maximum": 25375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14093.81, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10719.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7430.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7917.87, "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": 10293.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8313.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10689.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10689.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8313.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8313.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8709.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8047.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11085.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5217.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7917.87, "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": 7917.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22794, "minimum": 6580, "maximum": 40574.1566, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 40574.16, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32332.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22794.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 22411.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 22794.47, "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": 29632.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 22794.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 23934.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 30772.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30772.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22794.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 23934.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 23934.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25073.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 22794.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22794.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24392.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 31912.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11747.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22794.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 22794.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 22794.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22794.47, "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": 22794.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6954, "minimum": 3868.41, "maximum": 25375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12378.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9319.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6459.81 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6954.44, "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": 9040.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7302.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9388.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9388.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7302.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7302.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7649.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5439.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9736.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3868.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6954.44, "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": 6954.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7997.15, "discounted_cash": 405, "minimum": 340.59, "maximum": 7997.15, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 810.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 749.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 567.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 452.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 648.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 546.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 388.27 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 425.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 425.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 445.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1274.66, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 567.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 395.08 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Create Eardrum Opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9732.81, "discounted_cash": 1546, "minimum": 1123, "maximum": 9732.81, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3092.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2474.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2860.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2165.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1679.48 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1623.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2474.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2087.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1439.56 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1623.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1623.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1701.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1262.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4865.19, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2165.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1464.81 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10823, "minimum": 6210.75, "maximum": 33250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19265.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14940.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10823.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10355.73 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10823.19, "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": 14070.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10823.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11364.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14611.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14611.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10823.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11364.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11364.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11905.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10823.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10823.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9184.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15152.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6210.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10823.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10823.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10823.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10823.19, "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": 10823.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Deb Skin Bone At Fx Site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 2895, "minimum": 2277.858, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Diagnostic Colonoscopy", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 926, "minimum": 777.21, "maximum": 7371.71, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1483.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1714.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1297.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1033.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 973.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1483.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1251.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 886.02 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 973.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 973.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1019.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 777.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2916, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1297.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 901.56 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1853.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 926.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8979.6, "maximum": 28875, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11706.8 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9197, "minimum": 6246.24, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 16371.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12578.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8718.8 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9197.67, "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": 11956.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9657.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12416.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12416.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9657.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9657.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10117.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9856.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12876.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6246.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9197.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9197.67, "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": 9197.67, "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": 12828, "minimum": 5607.42, "maximum": 37625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22833.95, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17853 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12828.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12374.69 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12828.06, "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": 16676.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12828.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13469.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 17317.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17317.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12828.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13469.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13469.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14110.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12828.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12828.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13881.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17959.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5607.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12828.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12828.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12828.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12828.06, "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": 12828.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15847, "minimum": 6580, "maximum": 48125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 28209.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22240.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15847.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15415.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15847.91, "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": 20602.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15847.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 21394.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21394.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15847.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16640.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16640.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17432.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15847.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15847.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18660.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22187.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11037.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15847.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15847.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15847.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15847.91, "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": 15847.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7155, "minimum": 4755.66, "maximum": 21875, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12736.91, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9611.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6662.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7155.57, "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": 9302.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7513.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9660.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9660.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7513.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7513.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7871.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7629.04 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10017.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4755.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7155.57, "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": 7155.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10148.4, "discounted_cash": 5344, "minimum": 2233.7, "maximum": 10148.4, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10148.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8550.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9886.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7481.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5763.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5611.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8550.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7214.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4940.41 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5611.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5611.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5878.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4333.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10148.4, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7481.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2233.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5027.08 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% 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": 13385, "minimum": 6580, "maximum": 41125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23826.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18663.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13385.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12936.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13385.65, "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": 17401.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13385.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14054.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18070.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18070.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13385.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14054.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14054.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14724.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13385.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13385.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15532.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18739.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8446.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13385.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13385.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13385.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13385.65, "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": 13385.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52234 - OR36052234", "code_information": [ { "code": "52234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8542.82, "discounted_cash": 3513, "minimum": 898, "maximum": 8542.82, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7026.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6499.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3910.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4743.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3351.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3864.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2940.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8542.82, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3410.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% 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": 5547, "minimum": 3300.57, "maximum": 21000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9875.35, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7276.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5043.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5547.95, "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": 7212.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5825.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7489.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7489.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5825.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5825.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6102.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5158.18 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7767.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3300.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5547.95, "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": 5547.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52281 - OR36052281", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8542.82, "discounted_cash": 2083, "minimum": 898, "maximum": 8542.82, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4166.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3333.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3854.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2916.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2322.59 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2187.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3333.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2812.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1990.79 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2187.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2187.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2291.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1746.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6554.66, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2916.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2025.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12208, "minimum": 6580, "maximum": 40250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21730.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16952.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12208.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11750.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12208.21, "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": 15870.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12208.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12818.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16481.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16481.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12208.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12818.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12818.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13429.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12208.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12208.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14021.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17091.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8553.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12208.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12208.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12208.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12208.21, "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": 12208.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dexmedetomidine Hcl In Nacl 0.9% Iv Soln 400 Mcg/100Ml", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "00143952501", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11960.4, "discounted_cash": 5344, "minimum": 1403, "maximum": 11960.4, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10688.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8550.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9886.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7481.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5763.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5611.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8550.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7214.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4940.41 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5611.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5611.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5878.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4333.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11960.4, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7481.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5027.08 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5344.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4986, "minimum": 2519.79, "maximum": 18375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8875.2, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6459.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4477.61 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 4986.07, "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": 6481.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5235.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6731.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6731.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5235.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5235.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5484.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3938.62 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6980.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2519.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4986.07, "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": 4986.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14613, "minimum": 4207.5, "maximum": 26012.7598, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 26012.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20447.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14173.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14613.91, "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": 18998.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14613.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15344.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 19728.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19728.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15344.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16075.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14613.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10528.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20459.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4294.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14613.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14613.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14613.91, "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": 14613.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8799.1, "discounted_cash": 736, "minimum": 521.83, "maximum": 8799.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1362.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 694.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 994.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 594.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 810.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 521.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2317.44, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 605.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drain Lower Leg Lesion", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8911.79, "discounted_cash": 2895, "minimum": 898, "maximum": 8911.79, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8911.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Debride skin at fx site", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9811.38, "discounted_cash": 705, "minimum": 599.8, "maximum": 9811.38, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drain Thigh/Knee Lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14902.9, "discounted_cash": 2895, "minimum": 1123, "maximum": 14902.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9108.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17167, "minimum": 6580, "maximum": 48125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 30558.67, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24157.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16744.9 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 17167.79, "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": 22318.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 17167.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 18026.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 23176.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23176.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 18026.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 18026.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18884.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 17167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17167.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20780.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 24034.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14196, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17167.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 17167.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 17167.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17167.79, "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": 17167.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bronchoscope/Lavage", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 1774, "minimum": 898, "maximum": 17859.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3281.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2394.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1675.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1951.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1470.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5581.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1705.29 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3548.06, "additional_payer_notes": "200.00% 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": 15695, "minimum": 6580, "maximum": 44625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 27937.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22018.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15695.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15262.22 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 15695.45, "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": 20404.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 15695.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 16480.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 21188.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21188.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15695.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 16480.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 16480.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17265.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 15695.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15695.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12241.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 21973.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6885.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15695.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 15695.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 15695.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15695.45, "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": 15695.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5610, "minimum": 2306.85, "maximum": 18375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 9987.46, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7367.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5106.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5610.93, "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": 7294.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5891.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7574.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7574.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5891.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5891.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6172.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5005.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7855.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2306.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5610.93, "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": 5610.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6245, "minimum": 2590.77, "maximum": 19250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11116.3, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8289.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5745.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6245.11, "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": 8118.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8430.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8430.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6557.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6557.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6869.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7633.34 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8743.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2590.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6245.11, "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": 6245.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44405, "minimum": 6580, "maximum": 79041.0068, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 79041.01, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 63729.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 44173.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 44405.06, "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": 57726.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 44405.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 46625.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 59946.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 59946.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 46625.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 46625.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 48845.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 44405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44405.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36075.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 62167.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 24523.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44405.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 44405.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 44405.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 44405.06, "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": 44405.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Destruct Lesion 15 Or More", "code_information": [ { "code": "17111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9280.75, "discounted_cash": 199, "minimum": 169.39, "maximum": 9280.75, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 399.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 319.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 369.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 225.29 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 319.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.1 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 209.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 209.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 219.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 629.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 199.97, "additional_payer_notes": "100.00% of Medicare 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", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Dise Eval Slp Do Brth Flx Dx", "code_information": [ { "code": "42975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 1774, "minimum": 109.28, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3548.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3281.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2394.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1675.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1951.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1470.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5581.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1705.29 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7876, "minimum": 4968.6, "maximum": 30625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14019.9, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10658.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7388.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7876.35, "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": 10239.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8270.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10633.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10633.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8270.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8270.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8663.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7050.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11026.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4968.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7876.35, "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": 7876.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6560, "minimum": 4826.64, "maximum": 27125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11678.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8747.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6063.37 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6560.76, "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": 8528.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6888.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8857.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8857.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6888.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6888.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7216.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6545.19 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9185.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4826.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6560.76, "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": 6560.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Endoscopy Maxillary Sinus", "code_information": [ { "code": "31267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8670.96, "discounted_cash": 7034, "minimum": 1123, "maximum": 8670.96, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7848.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7385.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6727.45 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7385.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7385.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7737.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5901.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8670.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6845.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7034.21, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12499, "minimum": 6580, "maximum": 38500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22249.15, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17375.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12043.85 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12499.52, "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": 16249.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12499.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13124.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16874.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16874.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13124.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13124.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13749.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12499.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11500.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17499.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7878.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12499.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12499.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12499.52, "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": 12499.5, "additional_payer_notes": "100.00% 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": 34616, "minimum": 3475.71, "maximum": 61616.7648, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 61616.76, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 49507.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 34315.85 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 34616.16, "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": 45001.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 34616.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 36347.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 46731.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 46731.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 36346.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 36347.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38077.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 34616.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3475.71 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 48462.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 21826.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 34616.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 34616.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34616.16, "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": 34616.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6461, "minimum": 3903.9, "maximum": 19250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11501.06, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8603.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5963.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6461.27, "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": 8399.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6784.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8722.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8722.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6784.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6784.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7107.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5752.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9045.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3903.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6461.27, "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": 6461.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Diag laparo separate proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14501.56, "discounted_cash": 6025, "minimum": 1123, "maximum": 14501.56, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 12051.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9640.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11147.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8435.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6615.01 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6326.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9640.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8134.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5670.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6326.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6326.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6628.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4973.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14501.56, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8435.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5769.48 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Pelvis Bursa", "code_information": [ { "code": "26991", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10559.1, "discounted_cash": 1602, "minimum": 702, "maximum": 10559.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2964.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1814.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2163.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1555.32 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1762.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1364.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5042.06, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1582.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [ { "code": "31575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15252.91, "discounted_cash": 198, "minimum": 165.5, "maximum": 15252.91, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 397.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 368.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 278.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.12 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 318.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.67 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 208.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 208.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 218.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 278.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.98 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 198.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Pelvis Lesion", "code_information": [ { "code": "26990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8811.65, "discounted_cash": 3261, "minimum": 702, "maximum": 8811.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8811.65, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 100 Mg/10Ml", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "63323065210", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Diltiazem Hcl Iv For Soln 100 Mg", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "00409435003", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Esmolol Hcl-Sodium Chloride Iv Soln 2500 Mg/250Ml", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "10019005561", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "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": 7449, "minimum": 4542.72, "maximum": 28000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13259.29, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10038.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6957.88 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7449.04, "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": 9683.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7821.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10056.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10056.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7821.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7821.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8193.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8009.51 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10428.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4542.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7449.04, "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": 7449.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10070, "minimum": 4329.78, "maximum": 29750, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10070.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10070.19, "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": 10070.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17924.94, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13846.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10070.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9597.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10070.19, "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": 13091.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10070.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10573.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13594.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13594.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10070.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10573.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10573.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11077.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10070.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10070.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13176.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14098.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4329.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10070.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10070.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bronchoscope/Wash", "code_information": [ { "code": "31622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7482.29, "discounted_cash": 1774, "minimum": 702, "maximum": 7482.29, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3548.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3281.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2394.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1675.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1951.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1470.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5581.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1705.29 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9617, "minimum": 6580, "maximum": 32375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17119.74, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13189.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9141.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9617.83, "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": 12503.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10098.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12984.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12984.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10098.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10098.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10579.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8894.97 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13464.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7772.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9617.83, "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": 9617.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4987, "minimum": 3761.94, "maximum": 21000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8877.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6461.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4479.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 4987.5, "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": 6483.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5236.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6733.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6733.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5236.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5236.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5486.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4919.42 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6982.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3761.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4987.5, "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": 4987.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5793, "minimum": 2377.83, "maximum": 18375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10312.36, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7632.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5290.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5793.46, "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": 7531.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6083.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7821.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7821.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6083.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6083.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6372.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4277.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8110.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2377.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5793.46, "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": 5793.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5919, "minimum": 2448.81, "maximum": 17500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10536.59, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7815.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5417.53 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5919.43, "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": 7695.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6215.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 7991.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7991.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6215.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6215.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6511.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6595.86 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8287.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 2448.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5919.43, "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": 5919.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 904.03, "discounted_cash": 1646, "minimum": 271.209, "maximum": 904.03, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 904.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8373, "minimum": 5146.05, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 14904.12, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11380.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7888.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8373.1, "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": 10885.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8791.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 11303.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11303.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8791.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8791.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9210.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7544.88 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 11722.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5146.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8373.1, "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": 8373.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 152463, "minimum": 6580, "maximum": 271385.4394, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 271385.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 220720.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 152464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 152991.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 152463.73, "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": 198202.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 152463.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 160087.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 205826.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 205826.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 152464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 160086.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 160087.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 167710.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 152464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 152463.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 222047 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 213449.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 58984.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 152464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 152463.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 152463.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 152463.73, "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": 152464, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC BACK LES SC < 3 CM", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3394.93, "discounted_cash": 1646, "minimum": 898, "maximum": 3394.93, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3394.93, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Egd Diagnostic Brush Wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 903, "minimum": 702, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1807.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1446.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1672.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1265.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1063 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 949.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1446.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1220.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 911.15 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 949.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 949.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 994.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 799.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2843.95, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1265.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 927.13 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Les Sc 3 Cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc face-mm b9+marg 0.5 cm<", "code_information": [ { "code": "11440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4531.57, "discounted_cash": 705, "minimum": 599.8, "maximum": 4531.57, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6038, "minimum": 3726.45, "maximum": 23625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10749.37, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7989.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5537.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6038.97, "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": 7850.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6340.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8152.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8152.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6340.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6340.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6642.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4423.01 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8454.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3726.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6038.97, "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": 6038.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Tum Deep 5 Cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8313.94, "discounted_cash": 2895, "minimum": 2439.84, "maximum": 8313.94, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8313.94, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC FOREARM LES SC < 3 CM", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3093.58, "discounted_cash": 1646, "minimum": 898, "maximum": 3093.58, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3093.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3093.58, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc face-mm b9+marg 0.6-1 cm", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3474.18, "discounted_cash": 705, "minimum": 599.8, "maximum": 3474.18, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Finger Abscess", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 1646, "minimum": 702, "maximum": 7955.46, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6510.87, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 6510.87, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 0.6-1", "code_information": [ { "code": "11641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5924.73, "discounted_cash": 705, "minimum": 599.8, "maximum": 5924.73, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 3383.55, "10th_percentile": 3383.55, "90th_percentile": 3383.55, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Scrotum", "code_information": [ { "code": "54700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8323.06, "discounted_cash": 2083, "minimum": 898, "maximum": 8323.06, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4166.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3333.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3854.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2916.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2322.59 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2187.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3333.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2812.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1990.79 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2187.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2187.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2291.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1746.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6554.66, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2916.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2025.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2083.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc hand tum deep < 1.5 cm", "code_information": [ { "code": "26116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7820.65, "discounted_cash": 1646, "minimum": 898, "maximum": 7820.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 3.1-4", "code_information": [ { "code": "11644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6164.26, "discounted_cash": 1646, "minimum": 898, "maximum": 6164.26, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DX LARYNGOSCOPY WOPER SCOPE", "code_information": [ { "code": "31526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5866.07, "discounted_cash": 1774, "minimum": 898, "maximum": 5866.07, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3548.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3281.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2394.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1675.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1951.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1470.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5581.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1705.29 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7596.18, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 7596.18, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC HIPPELV TUM DEEP < 5 CM", "code_information": [ { "code": "27048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28701.08, "discounted_cash": 2895, "minimum": 1123, "maximum": 28701.08, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9108.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% 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": 9640, "minimum": 4152.33, "maximum": 29750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17160.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13222.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9164.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9640.73, "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": 12532.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10122.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13014.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13014.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10122.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10122.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10604.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10446 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13497.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9640.73, "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": 9640.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc snhfg mal+mrg >4 cm", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7419.17, "discounted_cash": 2895, "minimum": 898, "maximum": 7419.17, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7419.17, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Tum Deep < 5 Cm", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 2895, "minimum": 898, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7371.71, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12322, "minimum": 6580, "maximum": 43750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21933.18, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17117.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12322, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11865.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12322.01, "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": 16018.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12322.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12938.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16634.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16634.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12322, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12938.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12938.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13554.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12322, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12322.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12733.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17250.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7985.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12322, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12322.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12322.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12322.01, "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": 12322, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 1646, "minimum": 898, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 2500 Mg/250Ml (10 Mg/Ml)", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "44567081110", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Exc Neck Tum Deep 5 Cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9280.75, "discounted_cash": 2895, "minimum": 2439.84, "maximum": 9280.75, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9108.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 0.6-1 cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3796.45, "discounted_cash": 405, "minimum": 340.59, "maximum": 3796.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 648.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 749.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 567.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 452.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 648.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 546.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 388.27 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 425.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 425.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 445.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 340.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1274.66, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 567.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 395.08 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 405.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 810.34, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6119, "minimum": 3903.9, "maximum": 22750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 10893.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8107.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5619.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6119.85, "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": 7955.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6425.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8261.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8261.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6425.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6425.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6731.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5538.64 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8567.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3903.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6119.85, "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": 6119.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep 5 Cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10649.2, "discounted_cash": 2895, "minimum": 2439.84, "maximum": 10649.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9108.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ephedrine Sulfate Inj 50 Mg/Ml", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "76014000525", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Exc tr-ext b9+marg 1.1-2 cm", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1265.47, "discounted_cash": 705, "minimum": 379.641, "maximum": 1265.47, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1265.47, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1265.47 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 3568.76, "10th_percentile": 3568.76, "90th_percentile": 3568.76, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1265.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1265.47, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Esophagoscopy rigid trnso dx", "code_information": [ { "code": "43191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1898.21, "discounted_cash": 1912, "minimum": 453.24, "maximum": 1898.21, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1898.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1843.55 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1617.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 453.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1875.89 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1898.21, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 1646, "minimum": 702, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Excise parotid glandlesion", "code_information": [ { "code": "42415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5272.23, "discounted_cash": 5900, "minimum": 1581.669, "maximum": 5272.23, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5151 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2470 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5272.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5272.23 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5272.23 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5272.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Excise Submaxillary Gland", "code_information": [ { "code": "42440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14079.2, "discounted_cash": 5900, "minimum": 1123, "maximum": 14079.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11800.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9440.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10915.61, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8260.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6707.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9440.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7965.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5749.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6490.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14079.2, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8260.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5849.87 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore wound chest", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4095.96, "discounted_cash": 2056, "minimum": 1228.788, "maximum": 4095.96, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4095.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3131 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3804.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2776.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2262.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4095.96, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep 5 Cm/>", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 2895, "minimum": 2211.513, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7371.71, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Excision of anal lesion(s)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2320.18, "discounted_cash": 2766, "minimum": 696.054, "maximum": 2320.18, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2320.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2320.18 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2320.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2320.18 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2320.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore/Biopsy Eye Socket", "code_information": [ { "code": "67400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8799.1, "discounted_cash": 3918, "minimum": 1123, "maximum": 8799.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7836.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6269.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7249.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5485.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4275.56 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4114.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6269.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5289.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3664.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4114.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4114.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4310.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5485.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3729.06 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC ABD LES SC < 3 CM", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 904.03, "discounted_cash": 1646, "minimum": 271.209, "maximum": 904.03, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 904.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXCISION OLECRANON BURSA", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5213.77, "discounted_cash": 3261, "minimum": 1123, "maximum": 5213.77, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5213.77, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Esophagoscopy Rigid Trnso", "code_information": [ { "code": "43180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8799.1, "discounted_cash": 5900, "minimum": 1315.11, "maximum": 8799.1, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8260.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6707.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7965.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5749.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6490.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8799.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8260.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1315.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5849.87 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore/Treat Finger Joint - 26075 - OR36026075", "code_information": [ { "code": "26075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 3261, "minimum": 1403, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc 3 Cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9280.75, "discounted_cash": 2895, "minimum": 2439.84, "maximum": 9280.75, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9108.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exploration Of Knee Joint", "code_information": [ { "code": "27310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14221, "discounted_cash": 3261, "minimum": 1403, "maximum": 14221, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10259.8, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Etomidate Iv Soln 2 Mg/Ml", "drug_information": { "unit": 20, "type": "ML" }, "code_information": [ { "code": "00409669502", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Exploreirrigate tear ducts", "code_information": [ { "code": "68840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1430.73, "discounted_cash": 316, "minimum": 254.83, "maximum": 1430.73, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 632.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1430.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 506.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 585.25, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 338.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 332.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 506.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 427.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 332.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 332.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 347.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 995.24, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 442.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 295.6 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC FACE LES SBQ 2 CM<", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3417.28, "discounted_cash": 1646, "minimum": 1025.184, "maximum": 3417.28, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3417.28, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore Scrotum", "code_information": [ { "code": "55110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 3513, "minimum": 898, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7026.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6499.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3910.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4743.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3351.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3864.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2940.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3410.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep < 5 Cm", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 2895, "minimum": 898, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explrdecompress eye socket", "code_information": [ { "code": "67445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4078.59, "discounted_cash": 3918, "minimum": 1223.577, "maximum": 4078.59, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4078.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1627 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4078.59 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3664.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3214.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4078.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3729.06 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3918.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3480.28, "discounted_cash": 705, "minimum": 599.8, "maximum": 3480.28, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore/Treat Eye Socket", "code_information": [ { "code": "67412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8757.67, "discounted_cash": 2369, "minimum": 1627, "maximum": 8757.67, "payers_information": [ { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2488.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3791.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3199.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2267.23 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2488.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2488.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2606.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1988.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7454.92, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3317.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2307.01 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4739.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4489 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3791.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1627 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4383.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3317.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2369.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2645.1 } ] } ] }, { "description": "Exc Abdl Tum Deep < 5 Cm", "code_information": [ { "code": "22900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 2895, "minimum": 1403, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28413, "minimum": 6580, "maximum": 50575.6384, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 50575.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40495.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 28069.39 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 28413.28, "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": 36937.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 28413.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 29833.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 38357.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 38357.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 29833.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 29833.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 31254.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 28413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28413.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41249.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 39778.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13912.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28413.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 28413.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 28413.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28413.28, "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": 28413.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc hand les sc 1.5 cm>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7820.65, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 7820.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8953, "minimum": 4791.15, "maximum": 15937.3902, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 15937.39, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12224.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8473 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 8953.59, "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": 11639.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 9401.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 12087.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12087.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 9401.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 9401.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9848.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14060.9 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 12535.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4791.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8953.59, "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": 8953.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc F/E/E/N/L Mal+Mrg >4 Cm", "code_information": [ { "code": "11646", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21096, "discounted_cash": 2895, "minimum": 898, "maximum": 21096, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9108.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34122, "minimum": 6580, "maximum": 73500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 60737.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 48790.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33818.49 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 34122.28, "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": 44358.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 34122.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 35828.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 46065.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 46065.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 35828.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 35828.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 37534.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 34122.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48076 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 47771.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 18987.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34122.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 34122.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 34122.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 34122.28, "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": 34122.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hip Pelvis Les Sc 3 Cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10649.2, "discounted_cash": 2895, "minimum": 2439.84, "maximum": 10649.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9108.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11526, "minimum": 5997.81, "maximum": 30625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20516.4, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15961.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11526.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11063.56 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11526.07, "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": 14983.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11526.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12102.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15560.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15560.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11526.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12102.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12102.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12678.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11526.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11526.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19998 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16136.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5997.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11526.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11526.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11526.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11526.07, "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": 11526.1, "additional_payer_notes": "100.00% 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": 5998.05, "discounted_cash": 705, "minimum": 599.8, "maximum": 5998.05, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43081, "minimum": 6308.15, "maximum": 234937.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 76685.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 61806.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 42840.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 43081.6, "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": 56006.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 45235.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 58160.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 58160.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 45235.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 45235.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 47389.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6308.15 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 60314.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43081.6, "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": 43081.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 2.1-3cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3239.62, "discounted_cash": 705, "minimum": 599.8, "maximum": 3239.62, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 5075.32, "10th_percentile": 5075.32, "90th_percentile": 5165.95, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc face-mm b9+marg 2.1-3 cm", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6328.28, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 6328.28, "payers_information": [ { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10469, "minimum": 5181.54, "maximum": 18635.8702, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 18635.87, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14426.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10469.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9999.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10469.59, "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": 13610.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10469.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10993.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14133.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14133.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10469.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10993.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10993.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11516.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10469.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10469.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16561 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 14657.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5181.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10469.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10469.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10469.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10469.59, "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": 10469.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXPLORATION MAXILLARY SINUS", "code_information": [ { "code": "31256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2633.22, "discounted_cash": 3716, "minimum": 789.966, "maximum": 2633.22, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2633.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2633.22 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2633.22 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2633.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2633.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2633.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 0.5cm<", "code_information": [ { "code": "11640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5660.82, "discounted_cash": 705, "minimum": 599.8, "maximum": 5660.82, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6893, "minimum": 3939.39, "maximum": 23625, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12270.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9231.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6398.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6893.6, "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": 8961.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7238.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9306.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9306.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7238.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7238.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7582.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5424.41 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9651.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3939.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6893.6, "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": 6893.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore Parathyroid Glands", "code_information": [ { "code": "60500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12994.2, "discounted_cash": 5900, "minimum": 3898.26, "maximum": 12994.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11800.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5151 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9440.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10915.61, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8260.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6707.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9440.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7965.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5749.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6195.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6490.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5042.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12994.2, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8260.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5849.87 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5900.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 1.1-2", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5743.69, "discounted_cash": 705, "minimum": 599.8, "maximum": 5743.69, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 3383.55, "10th_percentile": 3383.55, "90th_percentile": 3383.55, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6392.9, "discounted_cash": 1602, "minimum": 702, "maximum": 6392.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 3723.58, "10th_percentile": 3723.58, "90th_percentile": 3723.58, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2964.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1814.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2163.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1555.32 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1762.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1364.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5042.06, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1582.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18136, "minimum": 6580, "maximum": 40250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 32283.75, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25565.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18136.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 17720.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 18136.94, "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": 23578.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 18136.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 19043.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 24484.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24484.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18136.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 19043.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 19043.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19950.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 18136.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18136.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20414.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 25391.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11924.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18136.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 18136.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 18136.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18136.94, "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": 18136.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 2.1-3", "code_information": [ { "code": "11643", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5608.2, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 5608.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12808, "minimum": 6580, "maximum": 22798.2756, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 22798.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17823.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12354.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12808.02, "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": 16650.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12808.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 17290.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17290.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 13448.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 13448.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14088.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12808.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10907.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17931.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7168.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12808, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12808.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12808.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12808.02, "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": 12808, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13918, "minimum": 6580, "maximum": 35000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24775.64, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19437.81 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13473.19 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13918.9, "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": 18094.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14614.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18790.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18790.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14614.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14614.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15310.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16347.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19486.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8233.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13918.9, "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": 13918.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Sc 1.5 Cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 2895, "minimum": 1662, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7371.71, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13372, "minimum": 6580, "maximum": 35000, "payers_information": [ { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14040.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14709.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13372.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12314 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 18720.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7843.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13372.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13372.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13372.05, "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": 13372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 23802.25, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18643.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12922.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13372.05, "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": 17383.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13372.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14040.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18052.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18052.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13372, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14040.65, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24103, "minimum": 6580, "maximum": 43750, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 42904.44, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34234.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24103.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23729.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 24103.62, "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": 31334.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 24103.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 25308.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 32539.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32539.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24103.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 25308.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 25308.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 26513.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 24103.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24103.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39138 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 33745.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13379.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24103.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 24103.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 24103.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24103.62, "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": 24103.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949, "minimum": 6105.4, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 12369.99, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9312.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6454.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6949.43, "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": 9034.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7296.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 9381.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9381.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7296.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7296.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7644.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6316.74 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 9729.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6139.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6949.43, "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": 6949.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Forearm Les Sc 3 Cm/>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11760, "minimum": 6580, "maximum": 35000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 20934.31, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16302.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11760.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11299.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11760.85, "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": 15289.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11760.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12348.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15877.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15877.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11760.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12348.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12348.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12936.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11760.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11760.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14536.7 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16465.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10717.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11760.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11760.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11760.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11760.85, "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": 11760.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fragmenting Of Kidney Stone", "code_information": [ { "code": "50590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9115.57, "discounted_cash": 3513, "minimum": 2734.671, "maximum": 23387.6, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7026.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5302 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6499.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3910.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5621.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4743.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3351.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3689.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3864.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2940.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9115.57, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4918.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3410.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3513.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg >4 Cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 2895, "minimum": 898, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6309, "minimum": 4459.08, "maximum": 24500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11230.96, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8382.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5810.37 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6309.53, "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": 8202.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6625.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8517.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8517.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6625.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6625.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6940.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4459.08 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8833.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5536.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6309.53, "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": 6309.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7482.29, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 7482.29, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9715, "minimum": 6580, "maximum": 33250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 17294.28, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13331.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9240.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 9715.89, "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": 12630.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 10201.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 13116.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13116.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 10201.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 10201.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10687.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12678.2 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 13602.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8766.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9715.89, "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": 9715.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28755 - OR36028755", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 7232, "minimum": 1403, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7592.86 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7592.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7064.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC NECK LES SC < 3 CM", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3616.18, "discounted_cash": 1646, "minimum": 898, "maximum": 3616.18, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3616.18, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fth gr fr fccmnaxghf", "code_information": [ { "code": "15240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3164.13, "discounted_cash": 2056, "minimum": 949.239, "maximum": 3164.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3164.13, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3164.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3164.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3164.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2776.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2262.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3164.13, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28725 - ", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7967.77, "discounted_cash": 12796, "minimum": 1403, "maximum": 7967.77, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7967.77 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7967.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7967.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7967.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7967.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Les Sc 3 Cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7753.52, "discounted_cash": 2895, "minimum": 2326.056, "maximum": 7753.52, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 5790.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 6326.71, "10th_percentile": 6326.71, "90th_percentile": 6326.71, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5356.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3244.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 4632.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3908.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2781.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3039.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3184.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2439.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7753.52, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4053.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2830.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2895.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16362, "minimum": 3126.17, "maximum": 56437.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 29125.34, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22988.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16362.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15934 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 16362.55, "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": 21271.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 16362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 17180.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 22089.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22089.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16362.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 17180.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 17180.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17998.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 16362.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3126.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 22907.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7914.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16362.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 16362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 16362.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16362.55, "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": 16362.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Foot Bones - 28730 - OR36028730", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17086.7, "discounted_cash": 12796, "minimum": 1403, "maximum": 17086.7, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14588.4 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12504.34 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14076.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10968.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17086.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12723.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc S/N/H/F/G Mal+Mrg 3.1-4", "code_information": [ { "code": "11624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7371.71, "discounted_cash": 1646, "minimum": 898, "maximum": 7371.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Ankle Joint Open", "code_information": [ { "code": "27870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20504.2, "discounted_cash": 12796, "minimum": 1403, "maximum": 20504.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 20504.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20474.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20504.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17914.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14588.4 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 20474.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17275.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12504.34 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13436.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14076.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10968.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20504.2, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17914.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12723.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12796.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20517, "minimum": 6580, "maximum": 59500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 36521.33, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29024.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 20118.25 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 20517.6, "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": 26672.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 21543.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 27698.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27698.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 21543.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 21543.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 22569.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25230 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 28724.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8659.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20517.6, "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": 20517.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Foot Bones - 28740 - OR36028740", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10649.2, "discounted_cash": 7232, "minimum": 1403, "maximum": 10649.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10649.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10649.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10649.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8099.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10649.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9763.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7955.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10649.2, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10125.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7064.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc snhfg mal+mrg 2.1-3", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4640.39, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 4640.39, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4640.39, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7559, "minimum": 5358.99, "maximum": 26250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13455.5, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10198.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7068.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7559.27, "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": 9827.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 7937.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10205.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10205.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 7937.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 7937.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8315.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7511.39 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10582.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5358.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7559.27, "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": 7559.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Forehead flap wvasc pedicle", "code_information": [ { "code": "15731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3797.31, "discounted_cash": 3532, "minimum": 1123, "maximum": 3797.31, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3130 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1123 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3797.31 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3708.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3557.84 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3708.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3708.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3120.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3797.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3620.26 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3532.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc thighknee les sc < 3 cm", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 904.03, "discounted_cash": 1646, "minimum": 271.209, "maximum": 904.03, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 904.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.03 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 904.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51879, "minimum": 6580, "maximum": 153562.5, "payers_information": [ { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 54473.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 54473.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 57067.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 51879.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51879.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29547.4 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 72631.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 28072.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51879.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 51879.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 51879.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 51879.87, "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": 51879.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 92346.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 74588.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51879.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 51700.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 51879.87, "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": 67443.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 51879.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 54473.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 70037.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 70037.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51879.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Excise intrspinl lesion lmbr", "code_information": [ { "code": "63267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3625.39, "discounted_cash": 7232, "minimum": 1087.617, "maximum": 3625.39, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 3625.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3625.39 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3625.39 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3625.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3625.39 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3625.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23593, "minimum": 6580, "maximum": 77437.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 41996.02, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33493.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23593.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 23215.53 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 23593.27, "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": 30671.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 23593.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 24772.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 31850.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31850.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23593.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 24772.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 24772.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25952.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 23593.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23593.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14963.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 33030.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12598.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23593.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 23593.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 23593.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23593.27, "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": 23593.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exploration Of Foot Joint", "code_information": [ { "code": "28022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14079.2, "discounted_cash": 3261, "minimum": 898, "maximum": 14079.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10259.8, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4433, "minimum": 3300.57, "maximum": 21000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 7891.61, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5657.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3921.15 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 4433.49, "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": 5763.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 4655.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 5985.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 5985.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 4655.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 4655.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4876.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3675.82 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 6206.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3300.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4433.49, "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": 4433.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXPLORE DEEP NODE(S) NECK", "code_information": [ { "code": "38542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6117.94, "discounted_cash": 6025, "minimum": 898, "maximum": 6117.94, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6117.94 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5670.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4973.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6117.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5769.48 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6025.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6192, "minimum": 4862.13, "maximum": 28000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11023.29, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8213.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5692.88 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6192.86, "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": 8050.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6502.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8360.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8360.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6502.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6502.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6812.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4959.79 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8670, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4862.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6192.86, "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": 6192.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore/Treat Finger Joint - 26080 - OR36026080", "code_information": [ { "code": "26080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7592.86, "discounted_cash": 1602, "minimum": 1364.32, "maximum": 7592.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3205.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2964.98, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1814.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2564.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2163.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1555.32 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1682.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1762.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1364.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5042.06, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2243.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1582.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1602.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11110, "minimum": 4897.62, "maximum": 41125, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19776.17, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15357.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10644.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11110.21, "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": 14443.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11110.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11665.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14998.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14998.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11665.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11665.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12221.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11110.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10746.6 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15554.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4897.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11110.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11110.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11110.21, "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": 11110.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Explore/Treat Knee Joint", "code_information": [ { "code": "27331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13036.2, "discounted_cash": 3261, "minimum": 1403, "maximum": 13036.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6522.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6033.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3678.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5217.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4402.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3153.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3424.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3587.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2765.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10259.8, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4565.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3208.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3261.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4213) 20+ Cc Syringe Only", "code_information": [ { "code": "A4213", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 5.6, "10th_percentile": 2.8, "90th_percentile": 8.4, "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": 11808, "minimum": 6580, "maximum": 52500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21018.4, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16371.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11347.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 11808.09, "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": 15350.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 11808.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12398.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 15940.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15940.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12398.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12398.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12988.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 11808.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13346.3 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 16531.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6672.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11808.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 11808.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 11808.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11808.09, "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": 11808.1, "additional_payer_notes": "100.00% 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": 153360, "minimum": 6580, "maximum": 341250, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 272981.85, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 222023.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 153361, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 153894.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 153360.59, "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": 199368.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 153360.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 161029.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 207036.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 207036.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 153361, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 161028.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 161029.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 168697.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 153361, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 153360.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 226151 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 214704.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 83614.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 153361, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 153360.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 153360.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 153360.59, "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": 153361, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4215) Sterile Needle", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 2.85, "10th_percentile": 2.8, "90th_percentile": 97.44, "count": "24" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14599, "minimum": 6580, "maximum": 25987.288, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 25987.29, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20426.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14158.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 14599.6, "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": 18979.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 15329.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 19709.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19709.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 15329.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 15329.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16059.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15989.8 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 20439.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7701.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14599.6, "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": 14599.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12153, "minimum": 6580, "maximum": 21633.7818, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 21633.78, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16873.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 11695.7 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 12153.81, "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": 15799.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 12153.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 12761.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 16407.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16407.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 12761.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 12761.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13369.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 12153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12153.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17208.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 17015.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6601.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12153.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 12153.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 12153.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12153.81, "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": 12153.8, "additional_payer_notes": "100.00% 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": 7857, "minimum": 4329.78, "maximum": 31500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 13985.51, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10630.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7368.74 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 7857.03, "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": 10214.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 8249.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 10606.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10606.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 8249.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 8249.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8642.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8364.21 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 10999.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4329.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7857.03, "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": 7857.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rem Interrog Pm/Ldls Pm <90 D Phys/Qhp", "code_information": [ { "code": "93294", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1485.58, "minimum": 23.91, "maximum": 1485.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.44 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.91 } ] } ] }, { "description": "Hc Low Cost Skin Substitute App", "code_information": [ { "code": "C5275", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2493.12, "discounted_cash": 597, "minimum": 597.18, "maximum": 3081.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1194.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 955.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1104.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 836.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 955.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 806.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 627.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 627.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 656.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1878.73, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 836.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 605.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 597.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prgrmg Dev Eval Scrms Phys/Qhp In Person", "code_information": [ { "code": "93285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.66, "discounted_cash": 37, "minimum": 15.66, "maximum": 185.66, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 74.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 68.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 59.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.24 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 39.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 39.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 40.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.03, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "100.00% of Medicare 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", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1535.58, "minimum": 460.674, "maximum": 1535.58, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 859.92, "10th_percentile": 859.92, "90th_percentile": 859.92, "count": "1 through 10" } ] } ] }, { "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", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 171.47, "10th_percentile": 171.47, "90th_percentile": 171.47, "count": "1 through 10" } ] } ] }, { "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": 10738, "minimum": 6580, "maximum": 35000, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 19113.66, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14816.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10269.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 10738.01, "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": 13959.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 10738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 11274.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 14496.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14496.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 11274.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 11274.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11811.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 10738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11176 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 15033.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9759.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10738, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 10738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 10738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10738.01, "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": 10738, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6320, "minimum": 5401.9, "maximum": 25375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 11250.06, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8398.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5821.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 6320.26, "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": 8216.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 6636.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 8532.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8532.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 6636.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 6636.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6952.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5473.36 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 8848.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5536.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6320.26, "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": 6320.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fth grf fr neel 20 sqcm<", "code_information": [ { "code": "15260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3473.11, "discounted_cash": 2056, "minimum": 898, "maximum": 3473.11, "payers_information": [ { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2776.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2262.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3473.11, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3473.11, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3473.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Fth grf fr sal 20 sq cm<", "code_information": [ { "code": "15220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4047.01, "discounted_cash": 2056, "minimum": 898, "maximum": 4047.01, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4047.01, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3804.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2776.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2262.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4047.01, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30384, "minimum": 3584.49, "maximum": 61687.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 54084.45, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43359.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30384.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 30054.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 30384.52, "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": 39499.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 30384.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 31903.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 41019.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 41019.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30384.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 31903.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 31903.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 33422.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 30384.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30384.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39758.1 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 42538.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3584.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30384.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 30384.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 30384.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30384.52, "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": 30384.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28750 - OR36028750", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9280.75, "discounted_cash": 7232, "minimum": 1403, "maximum": 9280.75, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 4081 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1403 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8099.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7593.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7955.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6089.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9280.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7064.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7232.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13624, "minimum": 6580, "maximum": 38500, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 24250.72, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19009.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13176.22 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 13624, "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": 17711.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 14305.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 18392.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18392.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 14305.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 14305.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14986.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14549.5 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 19073.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9440.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 13624, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13624, "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": 13624, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5051, "minimum": 3265.08, "maximum": 18375, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "case rate", "standard_charge_dollar": 8992.42, "additional_payer_notes": "178.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6555.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4543.92 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "case rate", "standard_charge_dollar": 5051.92, "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": 6567.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "case rate", "standard_charge_dollar": 5304.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "case rate", "standard_charge_dollar": 6820.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6820.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "case rate", "standard_charge_dollar": 5304.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "case rate", "standard_charge_dollar": 5304.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5557.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5859.84 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "case rate", "standard_charge_dollar": 6580 }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "case rate", "standard_charge_dollar": 7072.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3265.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medi medi", "methodology": "case rate", "standard_charge_dollar": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 5051.92, "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": 5051.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param", "code_information": [ { "code": "95783", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5133.68, "discounted_cash": 855, "minimum": 209.59, "maximum": 5133.68, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1711.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1369.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1583.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1198.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.52 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 898.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1369.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1155.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 988.73 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 898.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 898.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 941.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 867.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2692.69, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1198.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1006.08 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 855.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4565) Slings - A4565 - 27400063", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 299.5, "10th_percentile": 16.55, "90th_percentile": 300.3, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800001", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 602.28, "10th_percentile": 497.7, "90th_percentile": 1176, "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": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 2.85, "10th_percentile": 2.8, "90th_percentile": 73.87, "count": "14" } ] } ] }, { "description": "Hc (Sup Shell A4648) Implantable Tissue Marker - A4648 - 27800080", "code_information": [ { "code": "A4648", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 602.28, "10th_percentile": 497.7, "90th_percentile": 1176, "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": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 389.69, "10th_percentile": 389.69, "90th_percentile": 498.61, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1751) Cath Infus Insrt Periph Cntrl/Midln", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 703.95, "10th_percentile": 1.89, "90th_percentile": 967.68, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1753) Cath, Intravas Ultrasound", "code_information": [ { "code": "C1753", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 6525.4, "10th_percentile": 3567.21, "90th_percentile": 11908.29, "count": "15" } ] } ] }, { "description": "Hc (Sup Shell C1785) Pacemkr Dual Chamb Rate-Responsive", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", 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"methodology": "fee schedule", "standard_charge_dollar": 380.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 439.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 332.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 274.06 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 380.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 321.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234.91 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 249.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 249.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 261.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 748.15, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 332.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 239.03 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 237.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1176.87, "minimum": 11.38, "maximum": 1176.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.2 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.38 } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17526, "minimum": 1662, "maximum": 17526, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 9814.55, "10th_percentile": 9814.55, "90th_percentile": 9814.55, "count": "1 through 10" } ] } ] }, { "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": 1283.96, "discounted_cash": 781, "minimum": 177.29, "maximum": 1283.96, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1250.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1093.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 895.77 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 820.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1250.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1054.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 767.8 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 820.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 820.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 859.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1093.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 781.27 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.29, "discounted_cash": 46, "minimum": 1, "maximum": 223.29, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 93.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 86.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 74.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 51.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.82, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 46.67, "additional_payer_notes": "100.00% 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": 1490.43, "minimum": 29.93, "maximum": 1490.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.93 } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.92, "discounted_cash": 5, "minimum": 4.698, "maximum": 489.92, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.25 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.76, "discounted_cash": 18, "minimum": 15.64, "maximum": 94.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.57, "discounted_cash": 7, "minimum": 4.971, "maximum": 16.57, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.04 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.26, "discounted_cash": 15, "minimum": 13.788, "maximum": 212.26, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.24, "discounted_cash": 13, "minimum": 12.096, "maximum": 204.24, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.09 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.1 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aerosol Inhalation Treat For Pneum Carinii", "code_information": [ { "code": "94642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.83, "discounted_cash": 218, "minimum": 37.44, "maximum": 356.83, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 356.83, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 356.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 349.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 229.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 229.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 240.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.83, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 305.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,Complx/Prog", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 785.94, "discounted_cash": 94, "minimum": 78.25, "maximum": 785.94, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.07 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 127.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 104.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.08, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 189.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 175.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 94.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.35, "discounted_cash": 11, "minimum": 10.78, "maximum": 236.35, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15973.6, "discounted_cash": 3147, "minimum": 302.9, "maximum": 15973.6, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 302.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9900.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 986.73, "discounted_cash": 218, "minimum": 10.24, "maximum": 986.73, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 436.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 394.69, "10th_percentile": 394.69, "90th_percentile": 592.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 349.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 552.57, "10th_percentile": 552.57, "90th_percentile": 562.44, "count": "45" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 403.78, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 552.57, "10th_percentile": 552.57, "90th_percentile": 552.57, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 230.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 349.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.66 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 229.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 229.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 240.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 686.65, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 305.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.13 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 218.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9639, "discounted_cash": 3147, "minimum": 133.3, "maximum": 9639, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9639, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "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": 11941.8, "discounted_cash": 3147, "minimum": 120.78, "maximum": 11941.8, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 6687.39, "10th_percentile": 6687.39, "90th_percentile": 6687.39, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9900.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anorectal Manometry", "code_information": [ { "code": "91122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1407.81, "discounted_cash": 303, "minimum": 44.2, "maximum": 1407.81, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 607.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 562.01, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 318.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 486.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 410.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 318.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 318.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 334.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 955.72, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 425.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 307.93 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 303.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15967.9, "discounted_cash": 5546, "minimum": 127.66, "maximum": 15967.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11092.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7297.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10260.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6128.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7487.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5253.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4608.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15967.9, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5345.58 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.41, "discounted_cash": 4, "minimum": 4.275, "maximum": 104.41, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3339.98, "minimum": 40.11, "maximum": 3339.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.38 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 1870.39, "10th_percentile": 1870.39, "90th_percentile": 1870.39, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.11 } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.62, "discounted_cash": 4, "minimum": 4.275, "maximum": 82.62, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 47.09, "10th_percentile": 47.09, "90th_percentile": 47.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12219.4, "discounted_cash": 3147, "minimum": 134.54, "maximum": 12219.4, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 6842.88, "10th_percentile": 6842.88, "90th_percentile": 6965.08, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9900.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.43, "discounted_cash": 10, "minimum": 9.16, "maximum": 52.43, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.63 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14355.8, "discounted_cash": 3147, "minimum": 129.54, "maximum": 15973.6, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 8039.25, "10th_percentile": 8039.25, "90th_percentile": 8039.25, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9900.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% 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": 1547.79, "minimum": 464.337, "maximum": 1547.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1547.79 } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15802, "discounted_cash": 3147, "minimum": 154.58, "maximum": 15802, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9900.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.16, "discounted_cash": 12, "minimum": 3.948, "maximum": 13.16, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.16 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.37 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Spinal Selectv", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15969, "discounted_cash": 5546, "minimum": 250.32, "maximum": 15969, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11092.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7297.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10260.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6128.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7487.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5253.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4608.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15969, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5345.58 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.26, "discounted_cash": 58, "minimum": 5.39, "maximum": 173.26, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 117.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 108.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.72 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.26, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.02, "discounted_cash": 14, "minimum": 13.14, "maximum": 296.02, "payers_information": [ { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.24 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.48 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1119.83, "discounted_cash": 357, "minimum": 40.57, "maximum": 1119.83, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 714.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 660.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 482.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.58 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 392.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 306.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.83, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.71 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3990.53, "discounted_cash": 3147, "minimum": 1197.159, "maximum": 3990.53, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3990.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 3990.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3990.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1302.26, "minimum": 390.678, "maximum": 1302.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1302.26 } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.67, "discounted_cash": 42, "minimum": 23.601, "maximum": 78.67, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 78.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 67.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.23 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.92 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.99 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.97, "discounted_cash": 15, "minimum": 12.79, "maximum": 100.97, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.45 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1954.33, "discounted_cash": 347, "minimum": 206.69, "maximum": 1954.33, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 695.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 482.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 643.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 469.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 382.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1093.93, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.83, "discounted_cash": 5, "minimum": 4.66, "maximum": 138.83, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.31 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.9, "discounted_cash": 8, "minimum": 7.785, "maximum": 481.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 269.86, "10th_percentile": 269.86, "90th_percentile": 274.68, "count": "21" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 269.86, "10th_percentile": 269.86, "90th_percentile": 269.86, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.79 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.87, "discounted_cash": 38, "minimum": 32.83, "maximum": 364.87, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 61.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.63 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.76 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.76, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 956.9, "discounted_cash": 13, "minimum": 11.916, "maximum": 956.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 535.86, "10th_percentile": 535.86, "90th_percentile": 535.86, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.83 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.53, "discounted_cash": 14, "minimum": 12.38, "maximum": 245.53, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 137.5, "10th_percentile": 137.5, "90th_percentile": 137.5, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.11, "discounted_cash": 169, "minimum": 5.18, "maximum": 429.11, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 339.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 314.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 186.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.11, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.46 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androsterone", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1092.73, "discounted_cash": 25, "minimum": 21.72, "maximum": 1092.73, "payers_information": [ { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 40.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.22 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.59 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.69, "discounted_cash": 12, "minimum": 10.88, "maximum": 246.69, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 138.15, "10th_percentile": 138.15, "90th_percentile": 138.15, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.62 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218, "minimum": 1, "maximum": 218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.16, "discounted_cash": 11, "minimum": 10.04, "maximum": 149.16, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.35 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.75, "discounted_cash": 10, "minimum": 9.45, "maximum": 153.75, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15025, "discounted_cash": 504, "minimum": 453.6, "maximum": 15025, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1008, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 876.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 603.29 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 806.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 680.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 517.1 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 529.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 554.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 453.6 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 453.6, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 540.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 526.18 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cadmium", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.62, "discounted_cash": 23, "minimum": 20.09, "maximum": 121.62, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8683.24, "discounted_cash": 736, "minimum": 736.63, "maximum": 8683.24, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1362.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 994.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 810.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2317.44, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogens", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.24, "discounted_cash": 32, "minimum": 29.07, "maximum": 243.24, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 64.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.66 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.14 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 35.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.07 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.32, "discounted_cash": 161, "minimum": 8.196, "maximum": 27.32, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 10.93, "10th_percentile": 10.93, "90th_percentile": 10.93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.32 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.32 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrone", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.86, "discounted_cash": 24, "minimum": 21, "maximum": 255.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 49.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.87 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 39.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.05 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 723.99, "discounted_cash": 278, "minimum": 217.197, "maximum": 723.99, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 557.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 362, "10th_percentile": 362, "90th_percentile": 362, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 412.67, "10th_percentile": 412.67, "90th_percentile": 412.67, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 515.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 390.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 301.11 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 292.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 446.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 376.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 258.1 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 292.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 292.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 306.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 723.99, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 390.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.62 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 278.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethanol - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.73, "minimum": 1, "maximum": 402.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 330.24, "10th_percentile": 225.53, "90th_percentile": 330.24, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 225.53, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 834.14, "discounted_cash": 169, "minimum": 5.72, "maximum": 834.14, "payers_information": [ { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 339.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 314.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 186.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.19, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.46 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethosuximide", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.61, "discounted_cash": 16, "minimum": 14.706, "maximum": 191.61, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.39, "discounted_cash": 37, "minimum": 2.99, "maximum": 462.39, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 74.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "34" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 68.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.5 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 59.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.14 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 39.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 39.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 40.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.13, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.81 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 37.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "percent of total billed charges", "standard_charge_percentage": 80, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "1 through 10" } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.9, "discounted_cash": 14, "minimum": 13.41, "maximum": 263.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.29 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.2, "discounted_cash": 169, "minimum": 46.34, "maximum": 632.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 339.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 314.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 186.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.19, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.46 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Folic Acid, Rbc", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.87, "discounted_cash": 17, "minimum": 8.361, "maximum": 27.87, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.43 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Screen", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.39, "discounted_cash": 51, "minimum": 8.3, "maximum": 462.39, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 103.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "51" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 96.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 19.36, "10th_percentile": 19.36, "90th_percentile": 258.94, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.58 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 83.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.93 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 54.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 416.15, "10th_percentile": 416.15, "90th_percentile": 416.15, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 54.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 57.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.37, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 72.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.84 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 51.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "percent of total billed charges", "standard_charge_percentage": 80, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "1 through 10" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Modlg Antb", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.76, "discounted_cash": 12, "minimum": 10.24, "maximum": 94.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.37 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.5, "discounted_cash": 16, "minimum": 11.47, "maximum": 307.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreat,Serum Diff Rbc Abso", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.88, "discounted_cash": 58, "minimum": 29.38, "maximum": 224.88, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 117.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 127.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 108.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.72 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.95, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.9, "discounted_cash": 12, "minimum": 7.49, "maximum": 28.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.37 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.91, "discounted_cash": 16, "minimum": 14.74, "maximum": 302.91, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.74 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Enzym", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1719.25, "discounted_cash": 169, "minimum": 24.35, "maximum": 1719.25, "payers_information": [ { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 186.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.19, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.46 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 339.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 314.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "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": 161.77, "discounted_cash": 16, "minimum": 14.25, "maximum": 161.77, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemosiderin, Qual", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.53, "discounted_cash": 4, "minimum": 4.04, "maximum": 97.53, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1172.6, "minimum": 351.78, "maximum": 1172.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1172.6 } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9639, "discounted_cash": 3147, "minimum": 135.8, "maximum": 9639, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9639, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Inorganic Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.13, "discounted_cash": 4, "minimum": 4.266, "maximum": 359.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 204.7, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.68 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.87 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.68, "discounted_cash": 347, "minimum": 159.58, "maximum": 1009.68, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 695.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 482.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 643.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 469.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 382.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1009.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15973.6, "discounted_cash": 3147, "minimum": 129.54, "maximum": 15973.6, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 8039.25, "10th_percentile": 8039.25, "90th_percentile": 8039.25, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9900.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.69, "discounted_cash": 12, "minimum": 11.655, "maximum": 68.69, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.51 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 20.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.29 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.53 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2735.32, "discounted_cash": 347, "minimum": 194, "maximum": 2735.32, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 695.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 482.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 643.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 469.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 382.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1093.93, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.26, "discounted_cash": 58, "minimum": 5.39, "maximum": 173.26, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 117.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 108.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.72 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.26, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.13, "discounted_cash": 6, "minimum": 6.2, "maximum": 359.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 204.7, "count": "159" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 201.11, "10th_percentile": 7.19, "90th_percentile": 201.11, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.2, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "percent of total billed charges", "standard_charge_percentage": 80, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 201.11, "count": "1 through 10" } ] } ] }, { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1498.28, "discounted_cash": 305, "minimum": 251.65, "maximum": 1498.28, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 611.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1498.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 839.04, "10th_percentile": 839.04, "90th_percentile": 839.04, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 565.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 943.92, "10th_percentile": 943.92, "90th_percentile": 943.92, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 334.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 489.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 413.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 321.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 321.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 336.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 251.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 962.46, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 428.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.91 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.79, "discounted_cash": 12, "minimum": 7.83, "maximum": 91.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.37 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.96 } ] } ] }, { "description": "Hc Assay Of Lipoprotein(A)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.6, "discounted_cash": 14, "minimum": 12.888, "maximum": 152.6, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 85.46, "10th_percentile": 85.46, "90th_percentile": 85.46, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.9, "discounted_cash": 11, "minimum": 10.78, "maximum": 193.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.29 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.78 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.52, "discounted_cash": 11, "minimum": 5.38, "maximum": 603.52, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.19 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.16 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.95, "discounted_cash": 6, "minimum": 5.949, "maximum": 170.95, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 95.73, "10th_percentile": 95.73, "90th_percentile": 95.73, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase ,Isoenzymes", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.2, "discounted_cash": 14, "minimum": 13.3, "maximum": 122.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.43 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1547.79, "minimum": 464.337, "maximum": 1547.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1547.79 } ] } ] }, { "description": "Hc Assay Of Metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.26, "discounted_cash": 16, "minimum": 15.246, "maximum": 430.26, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 33.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.39 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.25, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.27, "discounted_cash": 4, "minimum": 4.39, "maximum": 103.27, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.39, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.09 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15231.3, "discounted_cash": 2056, "minimum": 2056.48, "maximum": 15231.3, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 4112.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3804.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4150.81 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 3290.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2776.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3557.84 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2159.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2262.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3120.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6469.69, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2879.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3620.26 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2056.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3992.12, "discounted_cash": 781, "minimum": 177.29, "maximum": 3992.12, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1562.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 1996.06, "10th_percentile": 1996.06, "90th_percentile": 1996.06, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1250.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1445.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1093.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 895.77 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 820.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1250.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1054.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 767.8 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 820.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 820.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 859.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2458.06, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1093.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 781.27 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 781.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Opiates - 80361 - 30100328", "code_information": [ { "code": "80361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.28, "minimum": 1, "maximum": 76.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 } ] } ] }, { "description": "Hc Assay Of Aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 772.18, "discounted_cash": 40, "minimum": 34.64, "maximum": 772.18, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 76.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.78 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 65.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.82 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.68, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.55 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 629.19, "discounted_cash": 132, "minimum": 109.89, "maximum": 629.19, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 265.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 245.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.15 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.27 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 417.19, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2780.05, "discounted_cash": 903, "minimum": 799.25, "maximum": 2780.05, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1807.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1446.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 1584.63, "10th_percentile": 1584.63, "90th_percentile": 1584.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1672.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1265.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1063 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 949.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1446.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1220.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 911.15 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 949.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 949.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 994.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 799.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2780.05, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1265.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 927.13 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 903.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Opiates - G0480 - 30100328", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.28, "discounted_cash": 114, "minimum": 10.4, "maximum": 633.89, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 229.56, "count": "33" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 225.53, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 76.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.9, "discounted_cash": 6, "minimum": 5.83, "maximum": 193.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 108.58, "10th_percentile": 108.58, "90th_percentile": 108.58, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.65 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.76 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.34, "discounted_cash": 161, "minimum": 134.52, "maximum": 788.34, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 323.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 315.34, "10th_percentile": 315.34, "90th_percentile": 315.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 299.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.35 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 178.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.53, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.04 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18598.8, "discounted_cash": 7773, "minimum": 5151, "maximum": 18598.8, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 15547.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5151 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12438.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14381.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10883.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8603.4 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8162.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 12438.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10494.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7374.34 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8162.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8162.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8551.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6468.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18598.8, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10883.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7503.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7773.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenobarbital", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.69, "discounted_cash": 15, "minimum": 13.77, "maximum": 246.69, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.97 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 24.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.7 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218, "discounted_cash": 114, "minimum": 10.4, "maximum": 633.89, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 218, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 229.56, "count": "33" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 225.53, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.41 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.99 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.99, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 912.15, "discounted_cash": 161, "minimum": 38.17, "maximum": 912.15, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 323.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 456.08, "10th_percentile": 456.08, "90th_percentile": 456.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 274.61, "10th_percentile": 274.61, "90th_percentile": 574.66, "count": "16" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 299.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.35 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 178.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.53, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.04 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.76, "discounted_cash": 18, "minimum": 15.64, "maximum": 94.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 29.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prolactin", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.11, "discounted_cash": 19, "minimum": 17.44, "maximum": 320.11, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.2 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 31.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Hdl Cholest", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.36, "discounted_cash": 8, "minimum": 7.37, "maximum": 127.36, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.55 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.16, "discounted_cash": 35, "minimum": 21.78, "maximum": 258.16, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 66.23 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.56 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 57.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.48 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 37.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 37.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 39.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.12 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 35.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.72, "discounted_cash": 32, "minimum": 29.358, "maximum": 511.72, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 65.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 52.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.47 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 35.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.06 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - 84153 - 30100312", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.73, "discounted_cash": 18, "minimum": 16.55, "maximum": 293.73, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 36.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.87 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.78, "discounted_cash": 20, "minimum": 17.69, "maximum": 270.78, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 33.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.35 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.73 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1119.83, "discounted_cash": 357, "minimum": 3.83, "maximum": 1119.83, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 714.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 660.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 482.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.58 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 392.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 306.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.83, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.71 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 397.84, "discounted_cash": 64, "minimum": 57.969, "maximum": 397.84, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 121.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.1 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 103.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 70.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.97 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.97, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.25 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Selenium", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.02, "discounted_cash": 25, "minimum": 21.7, "maximum": 257.02, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 51.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.56 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 40.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.2 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcitonin", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 725.14, "discounted_cash": 26, "minimum": 22.77, "maximum": 725.14, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 53.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.07 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 42.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.97 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins & Agglutinins, Incubated", "code_information": [ { "code": "86941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.17, "discounted_cash": 12, "minimum": 10.899, "maximum": 118.17, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.9, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 377.47, "discounted_cash": 16, "minimum": 14.25, "maximum": 377.47, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.07 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.5 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Theophylline", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.25, "discounted_cash": 14, "minimum": 12.726, "maximum": 77.25, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Total", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.8, "discounted_cash": 5, "minimum": 4.64, "maximum": 130.8, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.17 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.29 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.38 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Den Grad Sep", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992.48, "discounted_cash": 169, "minimum": 66.24, "maximum": 992.48, "payers_information": [ { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 186.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.19, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.46 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 339.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 106.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 314.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 271.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 166.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 178.29, "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": 11714.6, "discounted_cash": 3147, "minimum": 112.64, "maximum": 11714.6, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 6294.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 4249.13 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 6560.16, "10th_percentile": 6560.16, "90th_percentile": 6560.16, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5822.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3568.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5035.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4248.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3058.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3304.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3461.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2683.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9900.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4405.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1671.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3112.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3147.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroid Stim Immunoglobulins (Tsi)", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 544.99, "discounted_cash": 50, "minimum": 45.77, "maximum": 544.99, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 101.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 94.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.87 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.18 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 55.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.77 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.09 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carbamazepine Total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.04, "discounted_cash": 14, "minimum": 13.11, "maximum": 265.04, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% 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": 3417.9, "discounted_cash": 703, "minimum": 142.73, "maximum": 3417.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1407.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1125.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1301.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 984.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1125.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 949.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 738.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 738.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 773.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 590.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2213.4, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 984.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 684.82 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15969, "discounted_cash": 5546, "minimum": 170.82, "maximum": 15969, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11092.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7297.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 17885.29, "10th_percentile": 17885.29, "90th_percentile": 17885.29, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10260.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6128.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7487.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5253.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4608.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15969, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5345.58 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.9, "discounted_cash": 12, "minimum": 11.48, "maximum": 193.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.79, "discounted_cash": 10, "minimum": 9.6, "maximum": 309.79, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.86 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2735.32, "discounted_cash": 347, "minimum": 184, "maximum": 2735.32, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 695.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 482.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 643.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 469.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 382.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1093.93, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15969, "discounted_cash": 5546, "minimum": 145.8, "maximum": 15969, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11092.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7297.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 17885.29, "10th_percentile": 17885.29, "90th_percentile": 17885.29, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10260.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6128.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8873.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7487.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5253.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5823.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6100.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4608.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15969, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7764.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5345.58 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5546.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Troponin, Quant", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.13, "discounted_cash": 12, "minimum": 11.22, "maximum": 359.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.98 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 204.7, "count": "281" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 201.11, "count": "21" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.22, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.02 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "percent of total billed charges", "standard_charge_percentage": 80, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 201.11, "count": "1 through 10" } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.83, "discounted_cash": 27, "minimum": 9.549, "maximum": 31.83, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 31.83, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.83 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 31.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.52 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.02, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.02 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2200.65, "discounted_cash": 347, "minimum": 197.76, "maximum": 2200.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 695.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 482.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 643.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 469.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 382.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1093.93, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy Ablation Lesion", "code_information": [ { "code": "46615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2035.42, "discounted_cash": 2766, "minimum": 610.626, "maximum": 2035.42, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2035.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2035.42 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2035.42 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2035.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2035.42 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 2035.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Creatinine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.62, "discounted_cash": 5, "minimum": 4.66, "maximum": 121.62, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 68.11, "10th_percentile": 68.11, "90th_percentile": 68.11, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.31 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 107.4, "10th_percentile": 107.4, "90th_percentile": 183.12, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ck (Cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.13, "discounted_cash": 6, "minimum": 5.859, "maximum": 359.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 204.7, "count": "25" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.79 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.68, "discounted_cash": 347, "minimum": 204.64, "maximum": 1009.68, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 695.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 482.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 643.28, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 556.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 469.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 382.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1009.68, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 486.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 206.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 353.16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 347.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Detection Nos If", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 785.94, "discounted_cash": 16, "minimum": 14.49, "maximum": 785.94, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.81 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.52 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Phosphorus", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.77, "discounted_cash": 5, "minimum": 5.2, "maximum": 29.77, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.93 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cryoglobulin", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.3, "discounted_cash": 6, "minimum": 5.82, "maximum": 111.3, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.63 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 498.56, "discounted_cash": 19, "minimum": 17.667, "maximum": 498.56, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.5 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 31.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.67 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.5 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.43, "discounted_cash": 7, "minimum": 6.57, "maximum": 143.43, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.57, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.59, "discounted_cash": 5, "minimum": 4.3, "maximum": 113.59, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.55, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Free Thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.97, "discounted_cash": 9, "minimum": 8.118, "maximum": 209.97, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 117.58, "10th_percentile": 117.58, "90th_percentile": 117.58, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 12.18, "10th_percentile": 12.18, "90th_percentile": 143.54, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 5-Hiaa", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.2, "discounted_cash": 12, "minimum": 11.61, "maximum": 157.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.53, "discounted_cash": 10, "minimum": 9.729, "maximum": 44.53, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Vma", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.43, "discounted_cash": 15, "minimum": 13.95, "maximum": 182.43, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.41, "discounted_cash": 17, "minimum": 15.867, "maximum": 322.41, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 35.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 28.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.41 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - G0480 - 30100036", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.73, "discounted_cash": 114, "minimum": 10.4, "maximum": 633.89, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 229.56, "count": "33" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 225.53, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.41 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.99 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.99, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8683.24, "discounted_cash": 736, "minimum": 736.63, "maximum": 8683.24, "payers_information": [ { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2317.44, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1808.88 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1473.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1362.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1031.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2073.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1178.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 994.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1777.69 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 736.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 773.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 810.29, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vancomycin", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.17, "discounted_cash": 13, "minimum": 12.186, "maximum": 297.17, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 166.42, "10th_percentile": 166.42, "90th_percentile": 166.42, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Haptoglobin, Quant", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.15, "discounted_cash": 12, "minimum": 11.32, "maximum": 219.15, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.59, "discounted_cash": 9, "minimum": 8.739, "maximum": 113.59, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.62 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.14 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2579.27, "minimum": 773.781, "maximum": 2579.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 } ] } ] }, { "description": "Hc Assay Of Vip", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.41, "discounted_cash": 35, "minimum": 30.03, "maximum": 213.41, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 70.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 65.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.29 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 56.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.8, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.89 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.41, "discounted_cash": 17, "minimum": 16.128, "maximum": 322.41, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.45 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.71 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.31, "discounted_cash": 29, "minimum": 24.89, "maximum": 155.31, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 58.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 46.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.04 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 32.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.57 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Appl Interdental Fixation Device Non-Fx/Dislc", "code_information": [ { "code": "21110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7483.21, "discounted_cash": 1546, "minimum": 1262.77, "maximum": 7483.21, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3092.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2474.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 2860.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2165.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1679.48 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1623.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2474.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2087.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1439.56 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1623.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1623.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1701.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1262.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4865.19, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2165.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1464.81 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1546.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.61, "discounted_cash": 11, "minimum": 10.449, "maximum": 191.61, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Mercury", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.76, "discounted_cash": 16, "minimum": 13.82, "maximum": 231.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.68 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.97 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ascorbic Acid", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.14, "discounted_cash": 9, "minimum": 7.66, "maximum": 110.14, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 15.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.15 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 645.96, "discounted_cash": 161, "minimum": 134.52, "maximum": 645.96, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 323.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 299.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.35 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 3203.34, "10th_percentile": 3203.34, "90th_percentile": 3203.34, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 178.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.53, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.04 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.61, "discounted_cash": 21, "minimum": 19.107, "maximum": 300.61, "payers_information": [ { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.11, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.17 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 42.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.42 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 33.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.66, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Myoglobin", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.13, "discounted_cash": 12, "minimum": 11.628, "maximum": 359.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.26 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - 80346 - 30100410", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218, "minimum": 1, "maximum": 218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 629.19, "discounted_cash": 132, "minimum": 109.89, "maximum": 629.19, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 265.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 245.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.15 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.27 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 417.19, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Other Fluid Chlorides", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.8, "discounted_cash": 5, "minimum": 4.25, "maximum": 130.8, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.99 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.13 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.42, "discounted_cash": 14, "minimum": 12.28, "maximum": 74.42, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.83 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.93, "discounted_cash": 4, "minimum": 4.14, "maximum": 107.93, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.51 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.47, "discounted_cash": 132, "minimum": 101.541, "maximum": 338.47, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 265.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 245.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.15 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.27 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 338.47, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Synovial Fluid Mucin", "code_information": [ { "code": "83872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.05, "discounted_cash": 5, "minimum": 5.27, "maximum": 86.05, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.01 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.11 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Parathormone", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.91, "discounted_cash": 41, "minimum": 35.09, "maximum": 668.91, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 82.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 77.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.41 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.35 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.15, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.09 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.38, "discounted_cash": 6, "minimum": 5.949, "maximum": 205.38, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.78 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.34, "discounted_cash": 161, "minimum": 134.52, "maximum": 788.34, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 323.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 299.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.91 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 259.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.35 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 170.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 178.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.53, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.04 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 161.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Urine Urea-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.8, "discounted_cash": 5, "minimum": 5, "maximum": 130.8, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.65 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.8 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenytoin, Free", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.61, "discounted_cash": 13, "minimum": 12.38, "maximum": 191.61, "payers_information": [ { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 22.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.07, "discounted_cash": 12, "minimum": 11.169, "maximum": 164.07, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.96 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Flow Cytometry Each", "code_information": [ { "code": "86053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.14, "discounted_cash": 37, "minimum": 7.83, "maximum": 200.14, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 75.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.71 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Vit D, 1,25-Dihydroxy W Fractions", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.3, "discounted_cash": 38, "minimum": 32.73, "maximum": 477.3, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 71.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 61.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.5 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 42.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.65, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.19 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pregnenolone", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.13, "discounted_cash": 20, "minimum": 18.6, "maximum": 139.13, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.99, "discounted_cash": 5, "minimum": 4.608, "maximum": 108.99, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 61.03, "10th_percentile": 61.03, "90th_percentile": 89.37, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 61.03, "10th_percentile": 61.03, "90th_percentile": 61.03, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.35 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.39, "discounted_cash": 132, "minimum": 2.99, "maximum": 462.39, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 265.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.57 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "34" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 245.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.15 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 212.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.27 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 139.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 417.19, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 132.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "percent of total billed charges", "standard_charge_percentage": 80, "median_amount": 258.94, "10th_percentile": 258.94, "90th_percentile": 258.94, "count": "1 through 10" } ] } ] }, { "description": "Hc Assay Vit D, 25-Hydroxy W Fractions", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 454.35, "discounted_cash": 29, "minimum": 25.16, "maximum": 454.35, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 59.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 254.44, "10th_percentile": 254.44, "90th_percentile": 254.44, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.43 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 47.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.37 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 32.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.9 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Primidone", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.62, "discounted_cash": 16, "minimum": 14.93, "maximum": 121.62, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 33.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.86 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.32 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.85, "discounted_cash": 18, "minimum": 15.34, "maximum": 216.85, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 36.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.7, "discounted_cash": 8, "minimum": 7.26, "maximum": 176.7, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.28 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.42 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Non-Endocrine Receptor", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436, "discounted_cash": 36, "minimum": 32.91, "maximum": 436, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 73.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.77 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 58.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.52 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.18 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Albumin", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.13, "discounted_cash": 4, "minimum": 4.455, "maximum": 359.13, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 201.11, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.93 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.25 } ] } ] }, { "description": "Hc Assay Of Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.62, "discounted_cash": 13, "minimum": 11.95, "maximum": 230.62, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 129.15, "10th_percentile": 129.15, "90th_percentile": 129.15, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.62 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.95, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.11, "discounted_cash": 58, "minimum": 29.38, "maximum": 320.11, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 117.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 112.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 108.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.72 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.95, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Three Catecholamines", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.24, "discounted_cash": 25, "minimum": 22.725, "maximum": 243.24, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 50.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 40.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.73, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.37 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tacrolimus", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 612.7, "discounted_cash": 13, "minimum": 12, "maximum": 612.7, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Iga, Igd, Igg, Igm, Each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.25, "discounted_cash": 9, "minimum": 8.37, "maximum": 391.25, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 657.29, "10th_percentile": 657.29, "90th_percentile": 657.29, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1639.57, "discounted_cash": 305, "minimum": 142.73, "maximum": 1639.57, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 611.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1639.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 565.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 334.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 489.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 413.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.88 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 321.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 321.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 336.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 251.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 962.46, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 428.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 291.91 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Toxin Or Antitoxin", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.71, "discounted_cash": 19, "minimum": 17.766, "maximum": 104.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.63 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 31.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.77, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.61 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436, "discounted_cash": 25, "minimum": 22.92, "maximum": 436, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.92, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.59 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.16, "discounted_cash": 7, "minimum": 6.48, "maximum": 149.16, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 11.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Monoxide", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.52, "discounted_cash": 12, "minimum": 7.956, "maximum": 26.52, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.75 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.86 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc B Cells, Total Count", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.48, "discounted_cash": 37, "minimum": 33.957, "maximum": 217.48, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 75.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 71.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.17 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 60.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.71 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroxine Bndng Globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.75, "discounted_cash": 14, "minimum": 13.3, "maximum": 80.75, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.16 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.43 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin,Total", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.9, "discounted_cash": 11, "minimum": 10.287, "maximum": 263.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 22.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.73 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.94 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.66, "discounted_cash": 3, "minimum": 3.537, "maximum": 129.66, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.71 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.04 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.54, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.11 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bacterium, Antibody", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.33, "discounted_cash": 12, "minimum": 10.95, "maximum": 66.33, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tobramycin", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.65, "discounted_cash": 16, "minimum": 14.517, "maximum": 347.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.31 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.55 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.52, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.84 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 544.99, "discounted_cash": 6, "minimum": 5.5, "maximum": 544.99, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 305.19, "10th_percentile": 305.19, "90th_percentile": 310.64, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 305.19, "10th_percentile": 305.19, "90th_percentile": 305.19, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.63 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.39, "discounted_cash": 16, "minimum": 15, "maximum": 244.39, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.1 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Basic Metabolic Panel Calcium Total", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.22, "discounted_cash": 8, "minimum": 7.61, "maximum": 383.22, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 214.6, "10th_percentile": 214.6, "90th_percentile": 218.44, "count": "557" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 214.6, "10th_percentile": 214.6, "90th_percentile": 214.6, "count": "34" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1985.26, "10th_percentile": 1102.03, "90th_percentile": 5245.29, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.23, "discounted_cash": 11, "minimum": 10.71, "maximum": 63.23, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.45 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lidocaine", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.65, "discounted_cash": 14, "minimum": 13.22, "maximum": 75.65, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.58 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.34 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Myeloperoxidase", "code_information": [ { "code": "83876", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.57, "discounted_cash": 50, "minimum": 25.55, "maximum": 201.57, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 101.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.87 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 81.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.18 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 55.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.77 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.09 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bcr/Abl1 Gene Major Bp", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1358.49, "discounted_cash": 163, "minimum": 147.56, "maximum": 1358.49, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 327.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 196.25 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 262.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.22 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 180.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 171.17 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Potassium", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.17, "discounted_cash": 4, "minimum": 4.2, "maximum": 118.17, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.67 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.94 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Procalcitonin", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1345.86, "discounted_cash": 27, "minimum": 23.6, "maximum": 1345.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 54.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.22 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 753.68, "10th_percentile": 753.68, "90th_percentile": 753.68, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.59 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 43.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.93 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.42 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 17-Hydroxypregneno", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.43, "discounted_cash": 22, "minimum": 20.529, "maximum": 182.43, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.4 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bld Clot Factor Viii, Vw Fc Antigen", "code_information": [ { "code": "85246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.14, "discounted_cash": 22, "minimum": 19.5, "maximum": 118.14, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 36.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid Prostatic", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.24, "discounted_cash": 9, "minimum": 8.69, "maximum": 30.24, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.56 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.93, "discounted_cash": 27, "minimum": 24.45, "maximum": 139.93, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.52 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 43.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.87 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.36 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.73, "minimum": 1, "maximum": 402.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.78 } ] } ] }, { "description": "Hc Bld Clot Factor Viii, Vw Fc, Ristocetin Cofactr", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.22, "discounted_cash": 22, "minimum": 19.5, "maximum": 383.22, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 36.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Quantitative,Blood Glucose", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.99, "discounted_cash": 3, "minimum": 3.537, "maximum": 108.99, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 61.03, "10th_percentile": 61.03, "90th_percentile": 124.25, "count": "147" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 61.03, "10th_percentile": 3.93, "90th_percentile": 61.03, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.71 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.04 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 65.4, "10th_percentile": 32.7, "90th_percentile": 196.2, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.54, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.11 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Proinsulin", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.32, "discounted_cash": 26, "minimum": 22.69, "maximum": 298.32, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 53.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.95 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 42.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.38 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.02, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.86 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 614.98, "discounted_cash": 15, "minimum": 12.82, "maximum": 614.98, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.74 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Folic Acid Serum", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.07, "discounted_cash": 14, "minimum": 13.23, "maximum": 234.07, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 131.08, "10th_percentile": 131.08, "90th_percentile": 133.42, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Thyroid Stim Hormone", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.48, "discounted_cash": 16, "minimum": 15.12, "maximum": 268.48, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.11 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 22.68, "10th_percentile": 22.68, "90th_percentile": 22.68, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.54 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 150.35, "10th_percentile": 150.35, "90th_percentile": 153.03, "count": "37" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 150.35, "10th_percentile": 150.35, "90th_percentile": 153.03, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - G0103 - 30100312", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.73, "discounted_cash": 19, "minimum": 6.6, "maximum": 293.73, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.12 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Arsenic", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.98, "discounted_cash": 18, "minimum": 16.12, "maximum": 139.98, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 30.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Fungus Culture", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.7, "discounted_cash": 20, "minimum": 14.27, "maximum": 215.7, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 40.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.49 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 32.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.36 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assessment Of Aphasia", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 570.25, "discounted_cash": 94, "minimum": 32.76, "maximum": 570.25, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 189.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 175.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.24 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 151.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.49 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 99.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 99.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 104.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.15 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 94.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.27, "discounted_cash": 4, "minimum": 4.2, "maximum": 103.27, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.76 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.94 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.33, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218, "discounted_cash": 114, "minimum": 10.4, "maximum": 633.89, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 218, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 229.56, "count": "33" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 225.53, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.41 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.99 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.99, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Gases: Ph, Po2 & Pco2", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 388.96, "discounted_cash": 26, "minimum": 10.77, "maximum": 388.96, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.2 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 41.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.74 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.21 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bacteria Identification, Aerobic Isolate", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.95, "discounted_cash": 8, "minimum": 7.27, "maximum": 170.95, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 95.73, "10th_percentile": 95.73, "90th_percentile": 97.44, "count": "41" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 95.73, "10th_percentile": 95.73, "90th_percentile": 95.73, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.67 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.29 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 411.33, "10th_percentile": 234.74, "90th_percentile": 411.33, "count": "1 through 10" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sex Hormone Binding Globulin", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.71, "discounted_cash": 21, "minimum": 13.113, "maximum": 43.71, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 43.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.56, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.69 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium In Urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.36, "discounted_cash": 6, "minimum": 5.427, "maximum": 127.36, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.22 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.43, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Gases: Ph, Po2 & Pco2 W O2 Satu", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 601.22, "discounted_cash": 78, "minimum": 21.53, "maximum": 601.22, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 157.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 336.68, "10th_percentile": 336.68, "90th_percentile": 336.68, "count": "12" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 336.68, "10th_percentile": 82.23, "90th_percentile": 336.68, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.28 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 126.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 86.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.89, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.23 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Basic Metabolic Panel Calcium Ionized", "code_information": [ { "code": "80047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 409.61, "discounted_cash": 13, "minimum": 12.357, "maximum": 409.61, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatomedin", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.43, "discounted_cash": 21, "minimum": 19.13, "maximum": 182.43, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 42.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.44 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 34.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.86, "discounted_cash": 13, "minimum": 11.63, "maximum": 255.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% 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" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.37 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Platelet Aggregation", "code_information": [ { "code": "85576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.22, "discounted_cash": 24, "minimum": 21.17, "maximum": 562.22, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 49.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 314.84, "10th_percentile": 314.84, "90th_percentile": 314.84, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.82 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 39.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.56 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.42, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Beta 2 Glycoprotein I Antibody,Ea", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 505.99, "discounted_cash": 25, "minimum": 22.905, "maximum": 505.99, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 50.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.47 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 40.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.12 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.58 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroglobulin", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 499.93, "discounted_cash": 16, "minimum": 14.45, "maximum": 499.93, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.76 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.22 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.47 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.18, "discounted_cash": 13, "minimum": 12.05, "maximum": 227.18, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.98 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Smear,Micro Exam,Manual Diff Wbc", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.76, "discounted_cash": 3, "minimum": 3.23, "maximum": 20.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 11.63, "10th_percentile": 11.63, "90th_percentile": 11.83, "count": "27" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 11.63, "10th_percentile": 11.63, "90th_percentile": 11.63, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.97 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bilirubin Total", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.03, "discounted_cash": 5, "minimum": 4.518, "maximum": 117.03, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.15 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.24 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.06, "discounted_cash": 4, "minimum": 4.068, "maximum": 125.06, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 70.03, "10th_percentile": 70.03, "90th_percentile": 70.03, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.46, "discounted_cash": 18, "minimum": 16.91, "maximum": 299.46, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 37.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 30.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.62 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Body Fluid Cell Count W Diff", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 196.2, "discounted_cash": 5, "minimum": 4.76, "maximum": 196.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Of Thyroid,Percut", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2542.56, "discounted_cash": 705, "minimum": 599.8, "maximum": 2542.56, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 1411.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 1305.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 797.73 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 1129.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 952.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 683.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 741.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 776.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 599.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2220.42, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 988.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 695.77 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 705.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood, Other Source", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.66, "discounted_cash": 5, "minimum": 4.57, "maximum": 129.66, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.08 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.21 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.45, "discounted_cash": 24, "minimum": 21.42, "maximum": 151.45, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 48.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 38.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.81 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.24 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bone Biopsy,Trocar/Needle Deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5019.72, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 5019.72, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5019.72, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Neck/Chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7851.2, "discounted_cash": 1646, "minimum": 1381.22, "maximum": 7851.2, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3292.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1662 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3045.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2633.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2222.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1574.59 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1728.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1810.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1381.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5178.79, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2304.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1602.22 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1646.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.33, "discounted_cash": 5, "minimum": 4.89, "maximum": 119.33, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.91 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.86, "discounted_cash": 21, "minimum": 19.53, "maximum": 255.86, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.97 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.26 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bld Clot Factor Viii Test, Vw Fc, Multimet Anal", "code_information": [ { "code": "85247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.92, "discounted_cash": 22, "minimum": 19.5, "maximum": 374.92, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 36.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.03, "discounted_cash": 6, "minimum": 6.138, "maximum": 156.03, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.12 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethanol - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.73, "discounted_cash": 114, "minimum": 10.4, "maximum": 633.89, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 229.56, "count": "33" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 225.53, "10th_percentile": 225.53, "90th_percentile": 225.53, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 136.98 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 183.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.41 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.99 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.99, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.47 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Lavage", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17859.9, "discounted_cash": 1774, "minimum": 898, "maximum": 17859.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3548.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3281.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2394.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1675.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1951.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1470.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5581.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1705.29 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor V Test", "code_information": [ { "code": "85220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 414.19, "discounted_cash": 17, "minimum": 15, "maximum": 414.19, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.13 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 28.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.43 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sulfate", "code_information": [ { "code": "84392", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.27, "discounted_cash": 5, "minimum": 4.94, "maximum": 28.27, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.57 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 8.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.24, "discounted_cash": 13, "minimum": 12.267, "maximum": 243.24, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.44 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 136.21, "10th_percentile": 136.21, "90th_percentile": 138.65, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.99 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.27 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.23 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Diag W Lung Bx, Single Lobe", "code_information": [ { "code": "31628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17859.9, "discounted_cash": 3716, "minimum": 898, "maximum": 17859.9, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7432.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5945.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 898 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6874.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5202.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4180.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5945.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5016.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3583.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4087.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3143.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11690.72, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5202.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3645.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Occult Stool, 1-3 Simult, Non Can Screen", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.99, "discounted_cash": 4, "minimum": 3.807, "maximum": 69.99, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 39.19, "10th_percentile": 39.19, "90th_percentile": 39.89, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Valproic Acid, Total", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.69, "discounted_cash": 13, "minimum": 12.186, "maximum": 285.69, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of G6Pd Enzyme", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.63, "discounted_cash": 9, "minimum": 8.73, "maximum": 160.63, "payers_information": [ { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.13 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Therapeutic Aspir, Init", "code_information": [ { "code": "31645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8348.44, "discounted_cash": 1774, "minimum": 702, "maximum": 8348.44, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 3548.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 702 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 3281.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1955.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 2838.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2394.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1675.89 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 1862.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1951.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1470.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5581.1, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2483.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1705.29 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 1774.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Type Antigen Donor Reagent Serum, Ea Ag", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1119.83, "discounted_cash": 357, "minimum": 5.4, "maximum": 1119.83, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 714.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 660.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 482.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.58 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 392.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 306.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.83, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.71 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551.88, "discounted_cash": 20, "minimum": 18.216, "maximum": 551.88, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.23 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 32.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.77 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lactic Acid", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.41, "discounted_cash": 11, "minimum": 10.08, "maximum": 213.41, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 119.51, "10th_percentile": 119.51, "90th_percentile": 121.64, "count": "61" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 119.51, "10th_percentile": 119.51, "90th_percentile": 119.51, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.08 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy W Ebus Sampling 3/> Node", "code_information": [ { "code": "31653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18375.5, "discounted_cash": 3716, "minimum": 1346.54, "maximum": 18375.5, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 7432.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2488 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5945.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6874.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5202.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4180.27 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 5945.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5016.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3583.09 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 3901.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4087.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3143.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11690.72, "additional_payer_notes": "314.60% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5202.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1346.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3645.95 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 3716.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Typing, Patient Serum", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.07, "discounted_cash": 58, "minimum": 8.69, "maximum": 141.07, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 117.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 108.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.34 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 79.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.72 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 61.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.07, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 58.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Rbc Protoporphyrin", "code_information": [ { "code": "84202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.76, "discounted_cash": 14, "minimum": 12.2, "maximum": 70.76, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 28.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 22.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.73 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.16, "discounted_cash": 12, "minimum": 10.899, "maximum": 149.16, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.5 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.9, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brucella, Antibody", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.59, "discounted_cash": 8, "minimum": 7.59, "maximum": 71.59, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.69 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1119.83, "discounted_cash": 357, "minimum": 3.83, "maximum": 1119.83, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 714.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 660.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.84 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 571.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 482.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 349.58 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 375.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 392.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 306.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.83, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 500.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.71 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 357.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Bld/Serum Cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.67, "discounted_cash": 4, "minimum": 3.915, "maximum": 98.67, "payers_information": [ { "payer_name": "6 DEGREES", "plan_name": "6 DEGREES - COMMERCIAL", "methodology": "fee schedule", "standard_charge_dollar": 8.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 55.26, "10th_percentile": 55.26, "90th_percentile": 55.26, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.21 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.47 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.13, "discounted_cash": 6, "minimum": 6.03, "maximum": 359.13, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 57, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 204.7, "count": "77" }, { "payer_name": "BCBS", "plan_name": "BCBS Select", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 82, "median_amount": 201.11, "10th_percentile": 201.11, "90th_percentile": 201.11, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Healthsprings", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% 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": "Healthnet federal services Tricare", "plan_name": "Healthnet federal services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.02 }, { "payer_name": "Healthy Blue", "plan_name": "Healthy Blue Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Ambetter Sunflower", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.87 }, { "payer_name": "Home State", "plan_name": "Home State Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Kansas Superior", "plan_name": "Kansas Superior Select", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Missouri Medicare", "plan_name": "Missouri Medicare Select", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "NHC ADVANTAGE", "plan_name": "NHC ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PACE KC (Swope Health Services)", "plan_name": "PACE KC (Swope Health Services) Medicare Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "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 Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "Laboratory - 90.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC KS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC MO Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "UHC", "plan_name": "UHC Veterans Choice Program", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veteran Services", "methodology": "fee schedule",