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","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":50447.20,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":29022.36,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30874.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":29404.62,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":30949.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":24556.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":29404.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":29404.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":22413.94,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":49681.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":29404.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":29110.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":29110.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":29110.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":29110.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":29110.57,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":42636.70,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":41628.12,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":29992.71,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":45780.74,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":38683.06,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":50447.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":28493.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":28493.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":50447.20,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":34116.33,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":31168.90,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":29404.62,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":40872.42,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":47668.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":31275.89,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":44151.04,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":36471.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":28816.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":30392.11,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":30874.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":29992.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":29992.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":29992.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":29992.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":29992.71,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":31462.94,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":45577.16,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":45577.16,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":45577.16,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":30874.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":30874.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":30874.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":30874.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":30874.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":30874.85,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":29404.62,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":29698.67,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":29404.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28698.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":31756.99,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":39946.18,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":29698.67,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":32345.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":29698.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":29698.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":29698.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":29698.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":29698.67,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":29110.57,"methodology":"fee schedule"}]}]},{"description":"BONE DISEASES AND ARTHROPATHIES WITHOUT MCC ","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":12771.48,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":8132.55,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8651.65,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":8239.66,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":7511.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":6660.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":8239.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":8239.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":5883.52,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11437.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":8239.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":8157.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":8157.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":8157.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":8157.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":8157.27,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":11947.51,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":11664.89,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":7590.69,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":12371.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":8851.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":8074.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":7376.19,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":8651.65,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":23.45,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":22.88,"methodology":"fee schedule"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC ","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":21037.24,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":12428.91,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13222.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":12592.61,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":12331.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":10398.44,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":12592.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":12592.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":9491.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21037.24,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":12592.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":12466.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":12466.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":12466.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":12466.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":12466.68,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":18259.28,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":17827.36,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":12461.97,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":18907.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":14532.34,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":12340.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":12109.83,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":13222.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":12844.46,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":12844.46,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":12844.46,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":12844.46,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":12844.46,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":13474.09,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":19518.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":19518.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":19518.55,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":13222.24,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":13222.24,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":13222.24,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":13222.24,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":13222.24,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":13222.24,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":12592.61,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":12718.54,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":12592.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12290.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":13600.02,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":17107.06,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":12718.54,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":13851.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":12718.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":12718.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":12718.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":12718.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":12718.54,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":12466.68,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor VIII, VW factor, ristocetin cofactor ","code_information":[{"code":"103560","type":"CDM"},{"code":"85245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.62,"maximum":143.45,"gross_charge":2868.42,"discounted_cash":2868.42,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":143.45,"methodology":"fee 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":10021.15,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":9484.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8503.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":10021.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":10021.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":7511.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14602.30,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":10021.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9920.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9920.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9920.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9920.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9920.94,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":14530.67,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":14186.94,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9780.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":10822.84,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":13613.73,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":10121.36,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":11023.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":10121.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":10121.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":10121.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":10121.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":10121.36,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9920.94,"methodology":"fee schedule"}]}]},{"description":"Oncology (colorectal cancer), image analysis with artificial intelligence assessment of 4 histologic and immunohistochemical features (CD3 and CD8 within tumor-stroma border and tumor core), tissue, r 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":10869.43,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":16771.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":12675.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":10946.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":10562.29,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":11728.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10901.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":12063.09,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":15173.81,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":11281.23,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":12286.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":11281.23,"methodology":"fee 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charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8097.82,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":7712.21,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":6927.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":7334.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":7712.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":7712.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":6478.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12594.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":7712.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":7635.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":7635.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":7635.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":7635.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":7635.08,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":11182.70,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10918.17,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":7866.45,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":7866.45,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":7866.45,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":7866.45,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":7866.45,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":8252.06,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":11953.92,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":11953.92,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":11953.92,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":8097.82,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":8097.82,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":8097.82,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":8097.82,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":8097.82,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":8097.82,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":7712.21,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":7789.33,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":7712.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7527.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":8329.18,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":10477.03,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":7789.33,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":8483.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":7789.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":7789.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":7789.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":7789.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":7789.33,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":7635.08,"methodology":"fee schedule"}]}]},{"description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision ","code_information":[{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19.85,"maximum":243.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":126.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":126.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":126.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":99.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":99.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":99.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":20.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":117.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":117.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":117.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":83.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":63.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":61.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":70.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":65.64,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":21.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":95.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":122.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":20.26,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":29.38,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Devoted 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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":50266.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":55622.79,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":69966.25,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":52017.61,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":56652.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":52017.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":52017.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":52017.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":52017.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":52017.61,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":50987.55,"methodology":"fee schedule"}]}]},{"description":"SOFT TISSUE PROCEDURES WITH CC ","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":26184.48,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":15755.46,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16761.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":15962.98,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":16064.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12824.23,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":15962.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":15962.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":11705.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25944.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":15962.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":15803.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":15803.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":15803.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":15803.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":15803.35,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":23146.32,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":22598.79,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":16282.24,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":23762.37,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":20078.34,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":26184.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":15468.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":15468.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":26184.48,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":17707.99,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":16920.76,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":15962.98,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":22188.54,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":24742.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":16233.67,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":23968.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":18930.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":15643.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":15774.95,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":16761.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":16282.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":16282.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":16282.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":16282.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":16282.24,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":17080.39,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":24742.62,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":24742.62,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":24742.62,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":16761.13,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":16761.13,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":16761.13,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":16761.13,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":16761.13,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":16761.13,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":15962.98,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":16122.61,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":15962.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15579.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":17240.02,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":21685.71,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":16122.61,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":17559.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":16122.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":16122.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":16122.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":16122.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":16122.61,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":15803.35,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens ","code_information":[{"code":"V2210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":83.92,"maximum":695.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":87.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":90.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":86.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":86.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":86.52,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":86.52,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":86.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":86.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":86.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":86.52,"methodology":"fee 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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":41706.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":46151.08,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":58052.07,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":43159.80,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":47005.73,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":43159.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":43159.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":43159.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":43159.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":43159.80,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":42305.16,"methodology":"fee schedule"}]}]},{"description":"Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instabiit 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schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":413.51,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":413.51,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":386.83,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":280.12,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":280.12,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":280.12,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":280.12,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":280.12,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":280.12,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":266.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":268.11,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":320.14,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":506.88,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":269.45,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":346.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":274.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":274.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":274.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":274.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":274.78,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":268.11,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC ","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":65786.15,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":37409.73,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39797.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":37902.46,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":40359.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":29800.37,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":37902.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":37902.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":27199.82,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":60289.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":37902.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":37523.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":37523.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":37523.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":37523.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":37523.44,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":54958.57,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":53658.51,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":38660.51,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":59700.82,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":50445.02,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":65786.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":36727.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":36727.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":65786.15,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":44489.73,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":40176.61,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":37902.46,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":52684.42,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":62162.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":40785.62,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":56910.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":47561.55,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":37144.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":39633.13,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":39797.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":38660.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":38660.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":38660.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":38660.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":38660.51,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":40555.63,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":58748.81,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":58748.81,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":58748.81,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":39797.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":39797.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":39797.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":39797.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":39797.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":39797.58,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":37902.46,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":38281.48,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":37902.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":36992.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":40934.66,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":51490.49,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":38281.48,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":41692.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":38281.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":38281.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":38281.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":38281.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":38281.48,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":37523.44,"methodology":"fee schedule"}]}]},{"description":"Antibody identification; platelet antibodies ","code_information":[{"code":"103110","type":"CDM"},{"code":"86022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.70,"maximum":114.89,"gross_charge":2088.54,"discounted_cash":2088.54,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":114.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":114.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":114.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":90.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":90.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":90.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":83.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":83.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":83.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":106.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":106.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":106.24,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":75.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":57.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":55.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":63.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":59.52,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":85.68,"methodology":"fee 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"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10929.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":10410.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":13196.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":10632.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":12093.82,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":15212.46,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":11309.96,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":12317.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":11309.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":11309.96,"methodology":"fee 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"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":16680.98,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":24402.73,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":20619.42,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":26890.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":15846.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":15846.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":26890.11,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":18185.19,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":17335.13,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":16353.90,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":22731.92,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":25409.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":16671.13,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":24555.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":19440.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":16026.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":16200.05,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":17171.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":16680.98,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":16680.98,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":16680.98,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":16680.98,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":16680.98,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":17498.67,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":25348.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":25348.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":25348.55,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":17171.60,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":17171.60,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":17171.60,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":17171.60,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":17171.60,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":17171.60,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":16353.90,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":16517.44,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":16353.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27376.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15961.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":20316.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":25911.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":18713.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":17662.21,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":22216.77,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":16517.44,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":17989.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":16517.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":16517.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":16517.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":16517.44,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":16517.44,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":16190.36,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITH CC ","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":16263.00,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":16103.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":16103.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":16263.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":12669.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":12669.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":12795.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":10125.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":11754.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":11754.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":11871.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":14904.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":14904.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":15053.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10771.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":10258.47,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":9747.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":11675.72,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":10721.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9283.37,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":10258.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":10258.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":9053.23,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12159.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":10258.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":3204.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":3471.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":4128.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":10155.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":10155.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":10155.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":10155.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":10155.89,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":14874.78,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":14522.92,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":9599.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":10463.64,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":9631.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":8999.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9424.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":9940.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":9940.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9424.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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Plan","plan_name":"MCR","standard_charge_dollar":35.93,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":27.78,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC ","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":14429.27,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":9188.19,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9774.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":9309.21,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":8695.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":7815.72,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":9309.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9309.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":6904.32,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13421.76,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":9309.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9216.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9216.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9216.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9216.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9216.12,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":13498.35,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13179.05,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":8787.59,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":13977.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":10247.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":9123.02,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":8539.28,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":9774.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":9495.39,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":9495.39,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":9495.39,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":9495.39,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":9495.39,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":9960.85,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":14429.27,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":14429.27,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":14429.27,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":9774.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":9774.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":9774.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":9774.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":9774.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":9774.67,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":9309.21,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":9402.30,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":9309.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9085.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":10053.94,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":12646.56,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":9402.30,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":10240.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":9402.30,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":9402.30,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":9402.30,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":9402.30,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":9402.30,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9216.12,"methodology":"fee schedule"}]}]},{"description":"Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823) ","code_information":[{"code":"0030U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":131.45,"maximum":838.97,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":838.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":838.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":838.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":660.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":660.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":660.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":135.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":612.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":612.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":612.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":775.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":775.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":775.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":140.84,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":549.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":419.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":405.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":466.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":434.58,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":628.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":682.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":810.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":194.49,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":265.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":9740.76,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":9173.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8149.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":9740.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9740.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":7199.05,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13994.71,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":9740.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9643.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9643.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9643.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9643.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9643.36,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":14124.11,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13790.00,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9506.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":10520.03,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":13232.83,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":9838.17,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":10714.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":9838.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":9838.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":9838.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":9838.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":9838.17,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9643.36,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique ","code_information":[{"code":"87801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56.84,"maximum":439.07,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":439.07,"methodology":"fee 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schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":405.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":405.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":405.99,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":70.20,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":58.97,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":58.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":287.82,"methodology":"fee 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":14199.37,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":14111.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":14199.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":14199.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":14199.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":14057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":14057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":14057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":14057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":14057.38,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":20589.09,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":20102.05,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":14260.05,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":21320.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":16629.15,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":13915.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":13857.10,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":14909.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14483.36,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14483.36,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14483.36,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14483.36,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14483.36,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15193.33,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":22009.02,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":22009.02,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":22009.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":14909.34,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":14909.34,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":14909.34,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":14909.34,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":14909.34,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":14909.34,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14199.37,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":14341.36,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14199.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13858.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15335.32,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":19289.84,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":14341.36,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":15619.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":14341.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":14341.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":14341.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":14341.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":14341.36,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":14057.38,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches ","code_information":[{"code":"E2204","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":799.81,"maximum":1731.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":831.56,"methodology":"fee schedule"},{"payer_name":"American Health 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schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":30.16,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":29.43,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF PERSONALITY AND IMPULSE CONTROL ","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":27233.39,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":16329.01,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17371.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":16544.08,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":16707.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":1193.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":1339.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":1215.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":16544.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":16544.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":1009.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":1463.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":16544.08,"methodology":"fee 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diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":22996.27,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":25733.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":1017.00,"methodology":"per diem"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":24840.94,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":19688.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":16213.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":16406.86,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":17371.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":16874.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":16874.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":16874.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":16874.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":16874.96,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":17702.17,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":17371.28,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":17371.28,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":17371.28,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":17371.28,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":17371.28,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":17371.28,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":16544.08,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":16709.52,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":16544.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16147.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":17867.61,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":22475.13,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":16709.52,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":18198.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":16709.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":16709.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":16709.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":16709.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":16709.52,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":16378.64,"methodology":"fee schedule"}]}]},{"description":"Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific  patient by an individual ","code_information":[{"code":"635402","type":"CDM"},{"code":"L3760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":522.21,"maximum":4325.34,"gross_charge":1480.00,"discounted_cash":1480.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":542.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":565.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":538.36,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":780.62,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1065.95,"methodology":"fee schedule"},{"payer_name":"Devoted 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schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":1130.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":527.59,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":565.28,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":570.66,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":570.66,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":570.66,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":570.66,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of 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service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":91016.41,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":91926.57,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":91016.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":98297.72,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":123645.79,"methodology":"fee 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":18590.52,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":18973.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":29905.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $12398 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":40501.71,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $456984.00, reimbursement will be the lesser of (a) 26% of billable gross charges, or (b) $20042 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":34649.44,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $18386 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":18590.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":18590.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":25261.30,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282471.00, reimbursement will be the lesser of (a) 20.4% of billable gross charges, or (b) $11523 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":46351.79,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $472742.00, reimbursement will be the lesser of (a) 27.3% of billable gross charges, or (b) $21697 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":18590.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":20558.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":22267.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":26484.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. 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PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":23846.08,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":14476.82,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15400.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":14667.50,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":14629.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":11111.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":14667.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":14667.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":10141.63,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22479.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":14667.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":14520.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":14520.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":14520.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":14520.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":14520.83,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":21267.88,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":20764.78,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":14783.92,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":22023.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":17240.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":14374.15,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":14366.17,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":15400.88,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14960.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14960.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14960.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14960.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14960.85,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15694.23,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":22734.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":22734.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":22734.63,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":15400.88,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":15400.88,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":15400.88,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":15400.88,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":15400.88,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":15400.88,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14667.50,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":14814.17,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14667.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":13398.83,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":13224.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12185.80,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":13398.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":13398.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":10764.80,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20926.40,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":13398.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":13264.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":13264.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":13264.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":13264.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":13264.84,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":19428.30,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":18968.72,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":13364.19,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":20118.34,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":15584.46,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":13130.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":12986.56,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":14068.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":13666.81,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":13666.81,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":13666.81,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":13666.81,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":13666.81,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":14336.75,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":20768.19,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":20768.19,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":20768.19,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":14068.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":14068.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":14068.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":14068.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":14068.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":14068.77,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":13398.83,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":13532.82,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":13398.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13077.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":14470.74,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":18202.31,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":13532.82,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":14738.71,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":13532.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":13532.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":13532.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":13532.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":13532.82,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":13264.84,"methodology":"fee schedule"}]}]},{"description":"CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; duplication/deletion variants ","code_information":[{"code":"81222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":357.70,"maximum":2721.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":2721.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":2721.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":2721.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":2142.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":2142.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":2142.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":438.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":1987.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":1987.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":1987.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":2516.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":2516.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":2516.25,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":394.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":456.82,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":365.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":365.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":1783.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":1361.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":1313.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":1514.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":1409.63,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":470.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":2037.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":2211.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":2628.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":630.85,"methodology":"fee schedule"},{"payer_name":"Community Health Choice 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schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":456.75,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":448.12,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":604.75,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"CHIP","standard_charge_dollar":401.50,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":891.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STAR","standard_charge_dollar":401.50,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STARKIDS","standard_charge_dollar":401.50,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STARPLUS","standard_charge_dollar":401.50,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":913.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":1196.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":426.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":1196.44,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":456.82,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":461.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":461.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":461.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":461.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":461.17,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":456.82,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":674.36,"methodology":"fee 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":22269.11,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":32066.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":25968.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":20929.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":21639.84,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":22424.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":21783.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":21783.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":21783.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":21783.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":21783.33,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":22851.14,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":33102.13,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":33102.13,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":33102.13,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":22424.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":22424.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":22424.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":22424.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":22424.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":22424.02,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":21356.21,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":21569.77,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":21356.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20843.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":23064.71,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":29012.41,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":21569.77,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":23491.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":21569.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":21569.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":21569.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":21569.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":21569.77,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":21142.65,"methodology":"fee schedule"}]}]},{"description":"Face-to-face educational services related to the care of chronic kidney disease; individual, per session, per one hour ","code_information":[{"code":"G0420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":91.28,"maximum":1052.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":111.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":116.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":110.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":139.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":374.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":375.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":110.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":110.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":118.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":372.18,"methodology":"fee schedule"},{"payer_name":"CHC Harris 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D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative ","code_information":[{"code":"85380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.84,"maximum":63.70,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":63.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":63.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":63.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":10.27,"methodology":"fee 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"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":22551.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":26578.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":17742.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":17742.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":20909.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":20697.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":16460.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":16460.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":19401.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":20873.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":20873.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":24602.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22018.68,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":20970.17,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":21609.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":17003.92,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":20970.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":20970.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":15520.06,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":34400.91,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":20970.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":20760.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":20760.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":20760.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":20760.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":20760.47,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":30406.75,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":29687.47,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":21389.57,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":31964.51,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":27008.85,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":35222.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":20320.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":20320.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":35222.67,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":23820.32,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":22228.38,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":20970.17,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":29148.54,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":33282.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":21837.09,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":31486.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":25465.01,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":20550.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":21220.04,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":22018.68,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":21389.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":21389.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":21389.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":21389.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":21389.57,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":22438.08,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":32503.76,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":32503.76,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":32503.76,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":22018.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":22018.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":22018.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":22018.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":22018.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":22018.68,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":20970.17,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":21179.87,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":20970.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19703.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20466.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":14622.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":18649.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":15025.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":22647.78,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":28487.98,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":21179.87,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":23067.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":21179.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":21179.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":21179.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":21179.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":21179.87,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":20760.47,"methodology":"fee schedule"}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC ","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":12495.00,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":7255.79,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7718.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":7351.36,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":6527.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":6257.62,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":7351.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":7351.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":5527.91,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10746.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":7351.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":7277.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":7277.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":7277.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":7277.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":7277.84,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":10659.47,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10407.31,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":6596.60,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":11038.06,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":7692.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":7204.33,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":6410.20,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":7718.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":7498.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":7498.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":7498.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":7498.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":7498.38,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":7865.95,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":11394.60,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":11394.60,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":11394.60,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":7718.92,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":7718.92,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":7718.92,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":7718.92,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":7718.92,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":7718.92,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":7351.36,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":7424.87,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":7351.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7174.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":7939.46,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":9986.82,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":7424.87,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":8086.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":7424.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":7424.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":7424.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":7424.87,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":7424.87,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":7277.84,"methodology":"fee schedule"}]}]},{"description":"Makena, 10 mg ","code_information":[{"code":"9074","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":14.17,"maximum":30.36,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Cigna 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Healthcare","plan_name":"HIX","standard_charge_dollar":29.63,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":30.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Superior Health 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schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":6028.60,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":5687.36,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":5687.36,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":5971.73,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":8815.41,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":8815.41,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":8246.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":5971.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":5971.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":5971.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":5971.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":5971.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":5971.73,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":5687.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5715.80,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":6824.83,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":10805.98,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":5744.23,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":7393.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":5857.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":5857.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":5857.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":5857.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":5857.98,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":5715.80,"methodology":"fee schedule"}]}]},{"description":"NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC ","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":13363.55,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":8509.56,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9052.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":8621.64,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":7934.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":7470.32,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":8621.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":8621.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":6599.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12828.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":8621.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":8535.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":8535.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":8535.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":8535.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":8535.43,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":12501.38,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":12205.66,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":8018.15,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":12945.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":9350.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":8449.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":7791.58,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":9052.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":8794.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":8794.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":8794.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":8794.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":8794.08,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":9225.16,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":13363.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":13363.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":13363.55,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":9052.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":9052.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":9052.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":9052.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":9052.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":9052.73,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":8621.64,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":8707.86,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":8621.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8414.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":9311.38,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":11712.50,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":8707.86,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":9483.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":8707.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":8707.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":8707.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":8707.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":8707.86,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":8535.43,"methodology":"fee schedule"}]}]},{"description":"Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and exten ","code_information":[{"code":"97167","type":"CPT"}],"standard_charges":[{"modifiers":"GO|CO","modifiers_description":"Services delivered under an outpatient occupational therapy plan of care|Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","setting":"outpatient","minimum":85.47,"maximum":183.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":91.57,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":126.45,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":172.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":87.21,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":89.83,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":121.22,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":178.78,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":183.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":85.47,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":91.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":92.44,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":9277.51,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":8660.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8180.45,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":9277.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9277.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":7226.52,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14048.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":9277.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9184.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9184.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9184.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9184.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9184.74,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":13452.39,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13134.17,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":9463.06,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":12811.10,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":10824.91,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":14116.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":8989.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":8989.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":14116.94,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":9546.98,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":9834.16,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":9277.51,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":12895.74,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":13339.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":8752.12,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":13930.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":10206.15,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":9091.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":8504.81,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":9741.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":9463.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":9463.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":9463.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":9463.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":9463.06,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":9926.94,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":14380.14,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":14380.14,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":14380.14,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":9741.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":9741.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":9741.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":9741.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":9741.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":9741.39,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":9277.51,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":9370.29,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":9277.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9054.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":10019.71,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":12603.50,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":9370.29,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":10205.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":9370.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":9370.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":9370.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":9370.29,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":9370.29,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9184.74,"methodology":"fee schedule"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":25953.77,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":13993.11,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14886.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":14177.42,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":14086.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12828.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":14177.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":14177.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":11709.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25953.77,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":14177.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":14035.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":14035.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":14035.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":14035.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":14035.65,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":20557.26,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":20070.97,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":14460.97,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":20837.51,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":17606.93,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":22961.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":13737.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":13737.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":22961.48,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":15528.35,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":15028.07,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":14177.42,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":19706.61,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":21696.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":14235.49,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":21287.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":16600.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":13893.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":13833.24,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":14886.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14460.97,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14460.97,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14460.97,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14460.97,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14460.97,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15169.84,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":21975.00,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":21975.00,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":21975.00,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":14886.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":14886.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":14886.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":14886.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":14886.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":14886.29,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14177.42,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":14319.19,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14177.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13837.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15311.61,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":19260.03,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":14319.19,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":15595.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":14319.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":14319.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":14319.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":14319.19,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":14319.19,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":14035.65,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITH MCC ","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":58437.94,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":33391.72,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35523.11,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":33831.53,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":35851.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":28865.29,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":33831.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":33831.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":26346.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":58397.83,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":33831.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":33493.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":33493.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":33493.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":33493.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":33493.21,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":49055.72,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":47895.30,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":34508.16,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":53032.34,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":44810.39,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":58437.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":32782.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":32782.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":58437.94,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":39520.30,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":35861.42,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":33831.53,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":47025.83,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":55219.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":36229.93,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":50798.04,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":42249.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":33154.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":35206.17,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":35523.11,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":34508.16,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":34508.16,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":34508.16,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":34508.16,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":34508.16,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":36199.74,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":52438.87,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":52438.87,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":52438.87,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":35523.11,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":35523.11,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":35523.11,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":35523.11,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":35523.11,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":35523.11,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":33831.53,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":34169.85,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":33831.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":33019.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":36538.05,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":45960.13,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":34169.85,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":37214.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":34169.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":34169.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":34169.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":34169.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":34169.85,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":33493.21,"methodology":"fee schedule"}]}]},{"description":"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC ","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":84864.84,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":44982.10,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47853.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":45574.57,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":48855.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":41947.59,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":45574.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":45574.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":38287.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":84864.84,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":45574.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":45118.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":45118.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":45118.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":45118.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":45118.82,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":66083.13,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":64519.92,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":46486.06,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":72268.29,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":61064.07,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":79634.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":44161.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":44161.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":79634.63,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":53855.16,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":48309.04,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":45574.57,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":63348.65,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":75248.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":49371.30,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":68430.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":57573.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":44663.08,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":47976.20,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":47853.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":46486.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":46486.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":46486.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":46486.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":46486.06,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":48764.79,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":70640.58,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":70640.58,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":70640.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":47853.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":47853.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":47853.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":47853.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":47853.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":47853.30,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":45574.57,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":46030.32,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":45574.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":44480.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14442.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":8450.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":9941.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":8010.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15981.33,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":20102.44,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":14945.51,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":16277.28,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":14945.51,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":14945.51,"methodology":"fee 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Plan","plan_name":"MCRHMO","standard_charge_dollar":316.42,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":316.42,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":316.42,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":316.42,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":316.42,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":301.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":302.86,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":361.62,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":572.57,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":304.36,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":391.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":310.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":310.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":310.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":310.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":310.39,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":302.86,"methodology":"fee schedule"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC ","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":36185.35,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":20665.47,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21984.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":20937.66,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":21573.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":21071.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":20937.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":20937.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":18614.20,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36185.35,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":20937.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":20728.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":20728.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":20728.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":20728.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":20728.28,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":30359.61,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":29641.45,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":21800.71,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":31437.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":25422.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":20518.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":21184.69,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":21984.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":21356.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":21356.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":21356.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":21356.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":21356.41,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":22403.30,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":32453.37,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":32453.37,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":32453.37,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":21984.54,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":21984.54,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":21984.54,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":21984.54,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":21984.54,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":21984.54,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":20937.66,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":21147.04,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":20937.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20435.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":22612.67,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":28443.81,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":21147.04,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":23031.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":21147.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":21147.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":21147.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":21147.04,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":21147.04,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":20728.28,"methodology":"fee schedule"}]}]},{"description":"Bilateral hip, knee, ankle, foot device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and acces ","code_information":[{"code":"K1007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88300.94,"maximum":191166.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":91805.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":95583.49,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":97790.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":143220.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":131670.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":178640.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":154770.00,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":131996.25,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":180243.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":91031.90,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":88300.94,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":93762.86,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":126534.34,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":186615.39,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":191166.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":89211.26,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":95583.49,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":96493.81,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":96493.81,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of 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schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":8.51,"methodology":"fee schedule"}]}]},{"description":"OTHER MENTAL DISORDER DIAGNOSES ","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":17447.03,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":10977.81,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11678.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":11122.40,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":10703.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":1193.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":1339.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":1215.00,"methodology":"per 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25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":11122.40,"methodology":"fee 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"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":11344.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":11344.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":11344.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":11344.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":11344.85,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":11900.97,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":11678.52,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":11678.52,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":11678.52,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":11678.52,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":11678.52,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":11678.52,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":11122.40,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":11233.62,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":11122.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10855.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":12012.19,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":15109.78,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":11233.62,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":12234.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":11233.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":11233.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":11233.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":11233.62,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":11233.62,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":11011.18,"methodology":"fee schedule"}]}]},{"description":"Panitumumab injection ","code_information":[{"code":"9235","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":156.14,"maximum":334.58,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":160.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":167.29,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":231.02,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":315.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":164.11,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":221.46,"methodology":"fee schedule"},{"payer_name":"Molina 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":14843.86,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":14824.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12718.95,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":14843.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":14843.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":11609.02,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25731.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":14843.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":14695.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":14695.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":14695.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":14695.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":14695.42,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":21523.60,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":21014.45,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":15895.33,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":23514.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":18536.11,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":15347.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":15446.17,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":16443.68,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":15973.86,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":15973.86,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":15973.86,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":15973.86,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":15973.86,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":16756.90,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":24274.01,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":24274.01,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":24274.01,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":16443.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":16443.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":16443.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":16443.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":16443.68,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":16443.68,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":15660.65,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":15817.26,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":15660.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15284.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":16913.50,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":21274.99,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":15817.26,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":17226.72,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":15817.26,"methodology":"fee 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":15373.28,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":22814.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":17927.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":14890.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":14938.87,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":15953.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":15498.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":15498.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":15498.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":15498.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":15498.02,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":16257.73,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":23550.92,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":23550.92,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":23550.92,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":15953.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":15953.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":15953.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":15953.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":15953.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":15953.85,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":15194.14,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":15346.08,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":15194.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14829.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":16409.67,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":20641.24,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":15346.08,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":16713.55,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":15346.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":15346.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":15346.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":15346.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":15346.08,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":15042.20,"methodology":"fee schedule"}]}]},{"description":"Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time ","code_information":[{"code":"E2504","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":2087.74,"maximum":4519.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":2170.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2259.93,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":2152.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":2152.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":2152.31,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":2152.31,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":2152.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":2152.31,"methodology":"fee 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schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":2152.31,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":2087.74,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":2216.88,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":2991.71,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":4412.24,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":4519.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":2109.26,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":2259.93,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of 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schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":74.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":74.54,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":72.73,"methodology":"fee schedule"}]}]},{"description":"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS ","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":49239.86,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":28362.19,"methodology":"fee schedule"},{"payer_name":"Affiliated 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":28735.75,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":30208.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":24102.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":28735.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":28735.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":21999.55,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":48762.97,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":28735.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":28448.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":28448.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":28448.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":28448.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":28448.39,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":41666.84,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":40681.20,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28046.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":18163.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":24688.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":19562.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":31034.61,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":39037.52,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":29023.11,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":31609.33,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":29023.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":29023.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":29023.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":29023.11,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":29023.11,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":28448.39,"methodology":"fee schedule"}]}]},{"description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and m ","code_information":[{"code":"98968","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.15,"maximum":129.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":33.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35.28,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":33.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":48.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":129.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":129.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":33.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":33.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":40.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":128.83,"methodology":"fee schedule"},{"payer_name":"CHC Harris 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":24044.45,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":34448.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":28039.08,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":22483.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":23365.02,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":24089.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":23401.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":23401.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":23401.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":23401.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":23401.50,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":24548.64,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":35561.11,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":35561.11,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":35561.11,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":24089.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":24089.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":24089.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":24089.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":24089.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":24089.78,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":22942.65,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":23172.08,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":22942.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":122805.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22392.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":31066.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":116235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":83945.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":24778.06,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":31167.59,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":23172.08,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":25236.92,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":23172.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":23172.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":23172.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":23172.08,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":23172.08,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":22713.22,"methodology":"fee schedule"}]}]},{"description":"Pegunigalsidase alfa-iwxj ","code_information":[{"code":"715","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":219.08,"maximum":469.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":225.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":234.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Community Health 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Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":469.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":219.08,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":234.72,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":236.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":236.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":236.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":236.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":236.96,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":223.55,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":234.72,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":346.50,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":346.50,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":324.14,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":234.72,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":234.72,"methodology":"fee schedule"},{"payer_name":"Superior Health 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","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":12495.00,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":7326.38,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7794.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":7422.88,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":6606.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":6130.72,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":7422.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":7422.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":5415.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10528.14,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":7422.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":7348.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":7348.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":7348.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":7348.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":7348.65,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":10763.17,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10508.57,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":6676.64,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":11145.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":7785.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":7274.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":6487.98,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":7794.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":7571.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":7571.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":7571.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":7571.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":7571.33,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":7942.48,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":11505.46,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":11505.46,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":11505.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":7794.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":7794.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":7794.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":7794.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":7794.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":7794.02,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":7422.88,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":7497.10,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":7422.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7244.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":8016.71,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":10083.98,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":7497.10,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":8165.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":7497.10,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":7497.10,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":7497.10,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":7497.10,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":7497.10,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":7348.65,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) ","code_information":[{"code":"E2361","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":124.47,"maximum":269.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":129.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":134.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":186.06,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":254.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":124.47,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":132.17,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":178.36,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":263.06,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":269.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":125.75,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":134.74,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":136.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":136.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":136.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":136.02,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":136.02,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":134.74,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":198.90,"methodology":"fee 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schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":132.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":132.17,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":128.96,"methodology":"fee schedule"}]}]},{"description":"Pralatrexate injection ","code_information":[{"code":"9259","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":366.29,"maximum":784.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":376.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":541.96,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":740.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":384.98,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":519.54,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":766.22,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":784.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":366.29,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":396.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":396.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":396.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":396.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":396.19,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":579.34,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":579.34,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":541.96,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":392.46,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":373.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":375.64,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":448.52,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":710.16,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":377.51,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":485.90,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":384.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":384.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":384.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":384.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":384.98,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":375.64,"methodology":"fee schedule"}]}]},{"description":"PROSTATECTOMY WITH MCC ","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":50367.98,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":28979.04,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30828.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":29360.73,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":30900.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":22237.87,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":29360.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":29360.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":20297.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44989.78,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":29360.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":29067.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":29067.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":29067.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":29067.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":29067.12,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":42573.06,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":41565.99,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":31226.77,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":44085.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":36414.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":28773.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":30344.39,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":30828.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":29947.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":29947.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":29947.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":29947.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":29947.94,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":31415.98,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":45509.13,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":45509.13,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":45509.13,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":30828.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":30828.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":30828.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":30828.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":30828.77,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":30828.77,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":29360.73,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":29654.34,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":29360.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28656.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":31709.59,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":39886.55,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":29654.34,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":32296.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":29654.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":29654.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":29654.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":29654.34,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":29654.34,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":29067.12,"methodology":"fee schedule"}]}]},{"description":"PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome, PTEN hamartoma tumor syndrome) gene analysis; duplication/deletion variant ","code_information":[{"code":"81323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":246.96,"maximum":1876.44,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":1876.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":1876.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":1876.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":1477.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":302.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":1370.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":1370.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":1370.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":1735.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":1735.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":1735.08,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":272.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":315.00,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":300.00,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":252.00,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":252.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":1230.00,"methodology":"fee 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schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":303.51,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":219.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":219.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":219.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":219.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":219.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":219.79,"methodology":"fee schedule"},{"payer_name":"Texas Childrens Healthplans","plan_name":"STAR","standard_charge_dollar":175.00,"methodology":"fee schedule"},{"payer_name":"Texas Childrens 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schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":215.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":215.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":215.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":215.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":215.60,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":210.37,"methodology":"fee schedule"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC ","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":30664.70,"payers_information":[{"payer_name":"Accountable Health 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":18445.04,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":18812.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":15897.85,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":18445.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":18445.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":14043.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27301.01,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":18445.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":18260.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":18260.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":18260.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":18260.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":18260.59,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":26745.31,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":26112.64,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":18813.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":18813.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":18813.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":18813.94,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":18813.94,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":19736.19,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":28589.81,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":28589.81,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":28589.81,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":19367.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":19367.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":19367.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":19367.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":19367.29,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":19367.29,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":18445.04,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":18629.49,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":18445.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18002.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":19920.64,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":25057.59,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":18629.49,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":20289.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":18629.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":18629.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":18629.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":18629.49,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":18629.49,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":18260.59,"methodology":"fee schedule"}]}]},{"description":"SEPT9 (Septin9) (eg, colorectal cancer) promoter methylation analysis ","code_information":[{"code":"81327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":157.78,"maximum":1200.92,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":1200.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":1200.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":1200.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":945.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":945.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":945.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":193.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":876.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":876.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":876.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":1110.45,"methodology":"fee 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schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":579.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":668.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":622.08,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":899.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":976.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":1160.89,"methodology":"fee schedule"},{"payer_name":"Cigna 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":40097.63,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":42790.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":37632.64,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":40097.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":40097.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":34348.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":76135.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":40097.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":39696.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":39696.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":39696.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":39696.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":39696.65,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":58141.56,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":56766.21,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":43242.18,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":60206.59,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":50426.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":39295.68,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":42020.27,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":42102.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":40899.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":40899.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":40899.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":40899.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":40899.58,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":42904.46,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":62151.33,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":62151.33,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":62151.33,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":42102.51,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":42102.51,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":42102.51,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":42102.51,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":42102.51,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":42102.51,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":40097.63,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":40498.61,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":40097.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":39135.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":43305.44,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":54472.63,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":40498.61,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":44107.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":40498.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":40498.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":40498.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":40498.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":40498.61,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":39696.65,"methodology":"fee schedule"}]}]},{"description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and m ","code_information":[{"code":"98967","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.15,"maximum":86.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":32.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":86.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":86.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":24.49,"methodology":"fee 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schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":34.04,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":50.20,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":24.00,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":25.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health 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schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":416.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":416.74,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":416.74,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":406.62,"methodology":"fee schedule"}]}]},{"description":"URETHRAL STRICTURE ","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":14877.73,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":9473.76,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10078.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":9598.54,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":9016.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8398.12,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":9598.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9598.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":7418.80,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14421.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":9598.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9502.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9502.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9502.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9502.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9502.55,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":13917.88,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13588.65,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":9111.37,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":14412.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":10625.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":9406.57,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":8853.91,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":10078.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":9790.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":9790.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":9790.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":9790.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":9790.51,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":10270.44,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":14877.73,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":14877.73,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":14877.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":10078.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":10078.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":10078.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":10078.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":10078.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":10078.46,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":9598.54,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":9694.52,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":9598.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9368.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":10366.42,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":13039.61,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":9694.52,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":10558.39,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":9694.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":9694.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":9694.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":9694.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":9694.52,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9502.55,"methodology":"fee schedule"}]}]},{"description":"Variable asphericity lens, bifocal, full field, glass or plastic, per lens ","code_information":[{"code":"V2430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":139.29,"maximum":1153.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":144.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":150.78,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":208.22,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":284.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":1153.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":143.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":1153.80,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":139.29,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":147.91,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":199.60,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":294.38,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":301.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":140.73,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":150.78,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of 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"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":83945.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":37644.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":47351.28,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":35204.12,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":38341.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":35204.12,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":35204.12,"methodology":"fee 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schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":2541.77,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":2541.77,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":2668.86,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":3939.75,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":3939.75,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":3685.57,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":2668.86,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":2668.86,"methodology":"fee schedule"},{"payer_name":"Superior Health 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IPA","plan_name":"MCR","standard_charge_dollar":2567.19,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":3304.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":2618.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":2618.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":2618.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":2618.03,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":2618.03,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":2554.48,"methodology":"fee schedule"}]}]},{"description":"Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes ","code_information":[{"code":"97750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33.32,"maximum":360.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":34.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":44.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":118.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":119.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":34.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":34.36,"methodology":"fee 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":16399.41,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":16547.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":15939.87,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":16399.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":16399.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":14081.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27373.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":16399.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":16235.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":16235.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":16235.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":16235.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":16235.42,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":23779.14,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":23216.64,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":16722.07,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":24623.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":19500.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":16071.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":16249.55,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":17219.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":16727.40,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":16727.40,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":16727.40,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":16727.40,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":16727.40,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":17547.37,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":25419.09,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":25419.09,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":25419.09,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":17219.38,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":17219.38,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":17219.38,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":17219.38,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":17219.38,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":17219.38,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":16399.41,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":16563.40,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":16399.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":11909.11,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":11574.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":10034.38,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":11909.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":11909.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":8864.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17231.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":11909.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":11790.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":11790.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":11790.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":11790.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":11790.02,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":17268.21,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":16859.73,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":12147.29,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":17121.85,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":14467.34,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":18867.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":11539.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":11539.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":18867.09,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":12759.40,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":12623.66,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":11909.11,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":16553.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":17827.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":11697.08,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":17881.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":13640.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":11670.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":11366.55,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":12504.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":12147.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":12147.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":12147.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":12147.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":12147.29,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":12742.75,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":18459.12,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":18459.12,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":18459.12,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":12504.57,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":12504.57,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":12504.57,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":12504.57,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":12504.57,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":12504.57,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":11909.11,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":12028.20,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":11909.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11623.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":12861.84,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":16178.53,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":12028.20,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":13100.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":12028.20,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":12028.20,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":12028.20,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":12028.20,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":12028.20,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":11790.02,"methodology":"fee schedule"}]}]},{"description":"Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens ","code_information":[{"code":"V2101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":62.57,"maximum":518.27,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":65.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":93.54,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":127.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":518.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":518.27,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":62.57,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":66.45,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":89.67,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":132.25,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":135.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":63.22,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":68.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":68.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":68.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":68.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":68.38,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":93.54,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":67.74,"methodology":"fee schedule"},{"payer_name":"Superior Health 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schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":66.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":66.45,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":66.45,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":64.83,"methodology":"fee schedule"}]}]},{"description":"Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molde ","code_information":[{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":192.60,"maximum":1595.22,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":200.25,"methodology":"fee schedule"},{"payer_name":"American Health 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Care","plan_name":"WORKERSCOMP","standard_charge_dollar":273.13,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":145.19,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":186.88,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":148.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":148.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":148.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":148.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":148.06,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":144.47,"methodology":"fee schedule"}]}]},{"description":"Tracheostoma filter, any type, any size, each ","code_information":[{"code":"A4481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.48,"maximum":3.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":0.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":0.49,"methodology":"fee 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HealthSpring","plan_name":"PFFS","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":0.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":0.68,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":1.00,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":0.76,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":0.76,"methodology":"fee 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schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":0.49,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":0.49,"methodology":"fee schedule"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":14472.99,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":9103.16,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":9223.06,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":8600.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":7153.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":9223.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9223.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":6529.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14472.99,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":9223.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9130.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9130.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9130.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9130.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9130.83,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":13373.44,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13057.09,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":9407.52,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":12721.90,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":10749.54,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":14018.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":8937.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":8937.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":14018.65,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":9480.51,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":9776.44,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":9223.06,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":12820.05,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":13246.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":8691.18,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":13848.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":10135.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":9038.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":8445.59,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":9684.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":9407.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":9407.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":9407.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":9407.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":9407.52,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":9868.67,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":14295.74,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":14295.74,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":14295.74,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":9684.21,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":9684.21,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":9684.21,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":9684.21,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":9684.21,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":9684.21,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":9223.06,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":9315.29,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":9223.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9001.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":4.72,"methodology":"fee schedule"}]}]},{"description":"VIRAL MENINGITIS WITH CC/MCC ","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":25267.61,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":15254.11,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16227.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":15455.03,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":15501.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":13673.31,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":15455.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":15455.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":12078.85,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":23480.86,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":15455.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":15300.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":15300.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":15300.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":15300.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":15300.48,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":22409.79,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":21879.69,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":15764.13,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":22930.31,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":19375.28,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":25267.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":14975.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":14975.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":25267.61,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":17087.93,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":16382.33,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":15455.03,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":21482.49,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":23875.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":15665.23,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":23205.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":18267.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":15145.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":15222.57,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":16227.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":15764.13,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":15764.13,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":15764.13,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":15764.13,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":15764.13,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":16536.88,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":23955.30,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":23955.30,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":23955.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":16227.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":16227.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":16227.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":16227.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":16227.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":16227.78,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":15455.03,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":15609.58,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":15455.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15084.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":16691.43,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":20995.66,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":15609.58,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":17000.53,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":15609.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":15609.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":15609.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":15609.58,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":15609.58,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":15300.48,"methodology":"fee schedule"}]}]},{"description":"Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a s ","code_information":[{"code":"L4360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":295.49,"maximum":2447.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":307.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":441.71,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":603.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":2447.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":2447.47,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":295.49,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":313.77,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":423.44,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":624.49,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":639.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":298.54,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":322.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":322.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":322.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":322.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":322.91,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":472.18,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":472.18,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":441.71,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":319.86,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":304.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":306.15,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":365.56,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":578.80,"methodology":"fee schedule"},{"payer_name":"Van Lang 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IPA","plan_name":"MCR","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":30.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":23.72,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each ","code_information":[{"code":"608711","type":"CDM"},{"code":"A4435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7.62,"maximum":63.21,"gross_charge":146.00,"discounted_cash":146.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":7.86,"methodology":"fee 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schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":12.18,"methodology":"fee 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schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":7.90,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC ","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":33553.38,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":19501.54,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20746.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":19758.40,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":20267.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":16585.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":19758.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":19758.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":15137.70,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":33553.38,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":19758.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":19560.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":19560.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":19560.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":19560.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":19560.82,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":28649.68,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":27971.97,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":20481.03,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":29667.24,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":23883.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":19363.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":19902.29,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":20746.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":20153.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":20153.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":20153.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":20153.57,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":20153.57,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":21141.49,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":30625.52,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":30625.52,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":30625.52,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":20746.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":20746.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":20746.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":20746.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":20746.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":20746.32,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":19758.40,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":19955.98,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":19758.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19284.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":30054.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. 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"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19072.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":15068.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":21404.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":15458.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":21104.71,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":26546.99,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":19736.81,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":21495.54,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":19736.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":19736.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":19736.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":19736.81,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":19736.81,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":19345.99,"methodology":"fee schedule"}]}]},{"description":"Supprelin LA implant ","code_information":[{"code":"1142","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":44443.21,"maximum":95235.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":45735.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47617.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":45350.21,"methodology":"fee 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"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":25766.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":21461.95,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":26996.36,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":20070.90,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":21859.40,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":20070.90,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":20070.90,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":20070.90,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":20070.90,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":20070.90,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":19673.46,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, excursion amplifier, pulley type ","code_information":[{"code":"L6641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":221.78,"maximum":1836.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":230.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":228.64,"methodology":"fee 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Texas","plan_name":"PFFS","standard_charge_dollar":242.36,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":242.36,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":242.36,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":242.36,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":228.64,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":228.64,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":354.39,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":354.39,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":331.53,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":240.07,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":228.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":229.78,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":274.37,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":434.42,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":230.93,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":297.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":235.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":235.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":235.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":235.50,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":235.50,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":229.78,"methodology":"fee schedule"}]}]},{"description":"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC ","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":24845.11,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":15023.09,"methodology":"fee schedule"},{"payer_name":"Affiliated 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":15220.96,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":15242.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12020.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":15220.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":15220.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":10971.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":24319.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":15220.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":15068.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":15068.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":15068.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":15068.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":15068.75,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":22070.39,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":21548.31,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":15403.29,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":22854.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":17962.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":14916.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":14968.04,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":15982.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":15525.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":15525.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":15525.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":15525.38,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":15525.38,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":16286.43,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":23592.49,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":23592.49,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":23592.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":15982.01,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":15982.01,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":15982.01,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":15982.01,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":15982.01,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":15982.01,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":15220.96,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":15373.17,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":15220.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14855.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":16438.64,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":20677.67,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":15373.17,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":16743.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":15373.17,"methodology":"fee 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"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":68634.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":110899.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":141434.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":102143.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":75947.78,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":95532.46,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":71025.24,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":77354.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":71025.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":71025.24,"methodology":"fee 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":25292.24,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":26395.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":22115.04,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":25292.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":25292.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":20185.16,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44741.30,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":25292.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":25039.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":25039.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":25039.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":25039.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":25039.32,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":36673.75,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":35806.22,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":26673.82,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":37976.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":31105.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":24786.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":25920.09,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":26556.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":25798.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":25798.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":25798.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":25798.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":25798.08,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":27062.70,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":39202.97,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":39202.97,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":39202.97,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":26556.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":26556.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":26556.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":26556.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":26556.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":26556.85,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":25292.24,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":25545.16,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":25292.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24685.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":27315.62,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":34359.51,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":25545.16,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":27821.46,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":25545.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":25545.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":25545.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":25545.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":25545.16,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":25039.32,"methodology":"fee schedule"}]}]},{"description":"Holster for use with electric or electric/pneumatic ventricular assist device, replacement only ","code_information":[{"code":"Q0498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":590.50,"maximum":4890.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":613.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":882.70,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1205.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":4890.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":4890.84,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":590.50,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":627.02,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":846.18,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":1247.96,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":1278.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":596.58,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":645.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":645.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":645.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":645.29,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":645.29,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":608.76,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":943.58,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":943.58,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":882.70,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":639.20,"methodology":"fee schedule"},{"payer_name":"Superior Health 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schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":627.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":627.02,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":627.02,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":611.80,"methodology":"fee schedule"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH MCC ","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":22682.75,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":13840.71,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14724.16,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":14023.01,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":13915.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12882.49,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":14023.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":14023.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":11380.25,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22122.81,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":14023.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":13882.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":13882.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":13882.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":13882.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":13882.78,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":20333.36,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":19852.38,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":14062.69,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":21055.55,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":16399.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":13742.55,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":13665.32,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":14724.16,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14303.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14303.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14303.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14303.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14303.47,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15004.62,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":21735.67,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":21735.67,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":21735.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":14724.16,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":14724.16,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":14724.16,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":14724.16,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":14724.16,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":14724.16,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14023.01,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":14163.24,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14023.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13686.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15144.85,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":19050.26,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":14163.24,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":15425.31,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":14163.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":14163.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":14163.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":14163.24,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":14163.24,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":13882.78,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29) ","code_information":[{"code":"86300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.66,"maximum":130.20,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":130.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":130.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":130.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":102.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":102.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":102.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":20.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":95.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":95.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":95.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":120.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":120.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":120.39,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":85.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":62.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":72.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":67.42,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":22.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":96.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":105.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":124.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":30.17,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"CHIP","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"CHIPPerinatal","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"STAR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"STAR+PLUS","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":41.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCD","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"CHIP","standard_charge_dollar":18.70,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":42.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STAR","standard_charge_dollar":18.70,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STARKIDS","standard_charge_dollar":18.70,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STARPLUS","standard_charge_dollar":18.70,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":57.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":20.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":57.23,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":32.26,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":32.26,"methodology":"fee 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","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":23834.35,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":14470.41,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15394.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":14776.65,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":22013.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":17231.57,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":14367.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":14359.10,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":15394.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14954.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14954.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14954.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14954.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14954.22,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15687.27,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":22724.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":22724.55,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":22724.55,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":15394.05,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":15394.05,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":15394.05,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":15394.05,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":15394.05,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":15394.05,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14661.00,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":14807.61,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14661.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14309.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15833.88,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":19916.97,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":14807.61,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":16127.10,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":14807.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":14807.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":14807.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":14807.61,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":14807.61,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":14514.39,"methodology":"fee schedule"}]}]},{"description":"Inj ruxience, 10 mg ","code_information":[{"code":"9367","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":21.99,"maximum":47.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":22.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Cigna 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Healthcare","plan_name":"HIX","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":22.44,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":34.78,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":34.78,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":32.53,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":23.56,"methodology":"fee schedule"},{"payer_name":"Superior Health 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":29727.01,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":42072.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":34665.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":27460.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":28887.00,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":29421.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":28580.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":28580.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":28580.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":28580.96,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":28580.96,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":33624.66,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":43431.85,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":43431.85,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":43431.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":29421.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":29421.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":29421.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":29421.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":29421.58,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":29421.58,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":28020.55,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":28300.76,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":28020.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":30039.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27348.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":22294.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":28432.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":22908.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":30262.19,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":38065.92,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":28300.76,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":33624.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":28300.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":28300.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":28300.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":28300.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":28300.76,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":27740.34,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, power add-on to convert manual wheelchair to motorized wheelchair, tiller control ","code_information":[{"code":"E0984","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":252.85,"maximum":547.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":262.89,"methodology":"fee schedule"},{"payer_name":"American Health 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schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":268.49,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":261.97,"methodology":"fee schedule"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC ","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":41686.95,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":23051.09,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":23354.70,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":24249.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":20605.32,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":23354.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":23354.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":18807.18,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":41686.95,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":23354.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":23121.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":23121.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":23121.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":23121.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":23121.15,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":33864.32,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":33063.25,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":24505.57,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":35067.08,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":28576.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":22887.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":23813.11,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":24522.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. 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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22794.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":25223.08,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":31727.36,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":23588.25,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":25690.17,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":23588.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":23588.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":23588.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":23588.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":23588.25,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":23121.15,"methodology":"fee schedule"}]}]},{"description":"MSH6 (mutS homolog 6 ºE. coli») (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants ","code_information":[{"code":"81300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195.02,"maximum":1488.64,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":1488.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":1488.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":1488.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":1172.10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":1172.10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":1172.10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":240.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":1087.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":1087.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":1087.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":1376.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":1376.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":1376.50,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":215.91,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":249.90,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":199.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":199.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":975.80,"methodology":"fee 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schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":1437.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":345.10,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"CHIP","standard_charge_dollar":199.92,"methodology":"fee schedule"},{"payer_name":"Community Health Choice 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Texas","plan_name":"PPO","standard_charge_dollar":252.28,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":252.28,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":238.00,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":249.90,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":368.90,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":368.90,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":345.10,"methodology":"fee schedule"},{"payer_name":"Superior Health 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schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":245.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":245.14,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":245.14,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":239.19,"methodology":"fee schedule"}]}]},{"description":"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC ","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":72291.00,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":26313.02,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":27525.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":22386.28,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":26313.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":26313.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":20432.73,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":45290.04,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":26313.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":26049.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":26049.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":26049.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":26049.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":26049.89,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":38153.88,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":37251.34,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":25681.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":43140.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":68423.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":55129.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":28418.06,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":35746.24,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":26576.15,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":28944.32,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":26576.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":26576.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":26576.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":26576.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":26576.15,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":26049.89,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; identification of blood pathogen and resistance typing, when performed, by nucleic acid (DNA or RNA) probe, multiplexed amplified probe technique including multiplex reverse transcrip ","code_information":[{"code":"87154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.34,"maximum":1316.52,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":219.91,"methodology":"fee schedule"},{"payer_name":"Aetna Better 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":9743.20,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":9176.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":7304.42,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":9743.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9743.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":6666.99,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14777.69,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":9743.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9645.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9645.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9645.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9645.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9645.77,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":14127.64,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13793.45,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":9273.26,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":14629.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":10813.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":9548.34,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":9011.22,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":10230.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9509.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":10522.66,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":13236.14,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":9840.64,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":10717.52,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":9840.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":9840.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":9840.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":9840.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":9840.64,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9645.77,"methodology":"fee schedule"}]}]},{"description":"Hematology (heparin-induced thrombocytopenia), platelet antibody reactivity by flow cytometry, serum ","code_information":[{"code":"0275U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.00,"maximum":110.54,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"American Health 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":15084.06,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":22425.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":17590.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":14636.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":14657.82,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":15682.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":15234.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":15234.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":15234.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":15234.41,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":15234.41,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15981.20,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":23150.34,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":23150.34,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":23150.34,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":15682.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":15682.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":15682.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":15682.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":15682.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":15682.49,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14935.70,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":15085.06,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14935.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14577.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":16130.56,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":20290.15,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":15085.06,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":16429.27,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":15085.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":15085.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":15085.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":15085.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":15085.06,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":14786.34,"methodology":"fee schedule"}]}]},{"description":"Level 2 ENT Procedures ","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":508.10,"maximum":1088.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":522.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":544.40,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":751.79,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":534.03,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":720.68,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":1062.87,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":1088.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":508.10,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":544.40,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":549.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":549.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":549.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":549.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":549.58,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":518.47,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":544.40,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":803.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":803.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":751.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":544.40,"methodology":"fee schedule"},{"payer_name":"Superior Health 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","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2887.14,"maximum":6186.73,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":2971.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":4271.79,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5833.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":2946.06,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":3034.44,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":4095.03,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":6039.43,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":6186.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":2887.14,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":3122.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners 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schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":4566.40,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":4271.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":3093.37,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":14300.07,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":21374.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":16675.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":13950.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":13895.99,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":14946.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14519.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14519.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14519.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14519.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14519.83,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15231.59,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":22064.45,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":22064.45,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":22064.45,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":14946.89,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":14946.89,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":14946.89,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":14946.89,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":14946.89,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":14946.89,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14235.13,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":14377.48,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14235.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13893.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15373.94,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":19338.42,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":14377.48,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":15658.64,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":14377.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":14377.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":14377.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":14377.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":14377.48,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":14092.78,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each ","code_information":[{"code":"E2205","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":38.24,"maximum":82.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":57.16,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":38.24,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":40.60,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":54.79,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":80.81,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":82.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":38.63,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":41.79,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":61.10,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":61.10,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":57.16,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":41.39,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":39.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":39.62,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":47.30,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":74.90,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":40.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":40.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":40.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":40.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":40.60,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":39.62,"methodology":"fee schedule"}]}]},{"description":"MINOR SKIN DISORDERS WITH MCC ","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":23620.17,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":14353.29,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15269.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":14542.34,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":14490.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12707.69,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":14542.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":14542.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":11225.83,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21822.63,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":14542.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":14396.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":14396.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":14396.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":14396.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":14396.92,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":21086.39,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":20587.59,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":14833.19,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":21435.26,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":18112.01,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":23620.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":14091.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":14091.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":23620.17,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":15973.80,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":15414.88,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":14542.34,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":20213.85,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":22319.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":14643.86,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":21835.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":17076.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":14251.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":14230.06,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":15269.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14833.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14833.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14833.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14833.19,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14833.19,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15560.30,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":22540.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":22540.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":22540.63,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":15269.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":15269.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":15269.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":15269.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":15269.46,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":15269.46,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":14542.34,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":14687.76,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":14542.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14193.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15705.73,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":19755.77,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":14687.76,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":15996.57,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":14687.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":14687.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":14687.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":14687.76,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":14687.76,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":14396.92,"methodology":"fee schedule"}]}]},{"description":"Mucopolysaccharides, acid, quantitative ","code_information":[{"code":"83864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.54,"maximum":178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":178.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":178.26,"methodology":"fee 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Health","plan_name":"MGMCR","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":57.57,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":82.50,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":121.67,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":58.16,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":62.91,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":91.99,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":91.99,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":86.06,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":62.32,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":59.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":59.65,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":71.22,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":112.77,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":59.94,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":77.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":61.13,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":59.65,"methodology":"fee schedule"}]}]},{"description":"HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC ","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":44205.86,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":22720.60,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24170.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":23019.86,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":23878.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":21850.39,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":23019.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":23019.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":19943.60,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44205.86,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":23019.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":22789.66,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":22789.66,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":22789.66,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":22789.66,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":22789.66,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":33378.80,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":32589.22,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":24130.85,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":34564.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":28139.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":22559.46,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":23448.98,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":24170.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":23480.26,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":23480.26,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":23480.26,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":23480.26,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":23480.26,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":24631.25,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":35680.78,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":35680.78,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":35680.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":24170.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":24170.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":24170.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":24170.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":24170.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":24170.85,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":23019.86,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":23250.06,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":23019.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11545.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22467.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":24861.45,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":31272.48,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":23250.06,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":25321.85,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":23250.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":23250.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":23250.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":23250.06,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":23250.06,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":22789.66,"methodology":"fee schedule"}]}]},{"description":"Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing ","code_information":[{"code":"A6237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10.47,"maximum":86.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":10.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":21.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"CHC Harris 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":9522.14,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":8931.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8362.82,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":9522.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9522.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":7387.62,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14361.28,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":9522.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":9426.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":9426.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":9426.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":9426.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":9426.92,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":13807.11,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13480.50,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":9712.58,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":13211.82,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":11163.51,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":14558.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":9226.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":9226.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":14558.51,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":9845.60,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":10093.47,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":9522.14,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":13235.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":13756.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":9025.88,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":14297.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":10525.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":9331.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":8770.83,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":9998.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":9712.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":9712.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":9712.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":9712.58,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":9712.58,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":10188.69,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":14759.32,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":14759.32,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":14759.32,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":9998.25,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":9998.25,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":9998.25,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":9998.25,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":9998.25,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":9998.25,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":9522.14,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":9617.36,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":9522.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9293.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":10283.91,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":12935.83,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":9617.36,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":10474.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":9617.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":9617.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":9617.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":9617.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":9617.36,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9426.92,"methodology":"fee schedule"}]}]},{"description":"Inj pegfilgrastim-bmez 0. ","code_information":[{"code":"9345","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":339.82,"maximum":728.19,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":349.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":502.79,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":686.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":357.16,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":481.99,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":710.85,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":728.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":339.82,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":367.56,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":367.56,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":367.56,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":367.56,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":367.56,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":537.47,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":537.47,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":502.79,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":364.09,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":348.49,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":416.11,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":658.83,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":350.22,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":450.78,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":357.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":357.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":357.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":357.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":357.16,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":348.49,"methodology":"fee schedule"}]}]},{"description":"Inj, Ado-trastuzumab Emt ","code_information":[{"code":"9131","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":39.64,"maximum":84.93,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":40.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":42.47,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Corvel 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Plan","plan_name":"MCR","standard_charge_dollar":78.20,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":61.95,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":60.45,"methodology":"fee schedule"}]}]},{"description":"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC ","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":51933.12,"payers_information":[{"payer_name":"Accountable Health 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":29676.07,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":31249.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_percentage":37.90,"standard_charge_algorithm":"Reimbursement will be 37.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_percentage":26.00,"standard_charge_algorithm":"Reimbursement will be 26% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges","additional_payer_notes":" If billable gross charges 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service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":29676.07,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":29972.83,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":29676.07,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare 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schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":29972.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":29972.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":29972.83,"methodology":"fee schedule"}]}]},{"description":"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC ","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":29222.58,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":17202.55,"methodology":"fee schedule"},{"payer_name":"Affiliated 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":17429.13,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":17687.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":14444.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":17429.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":17429.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":13183.85,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29222.58,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":17429.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":17254.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":17254.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":17254.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":17254.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":17254.84,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":25272.24,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":24674.42,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":17874.40,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":26169.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":20843.97,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":17080.55,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":17369.32,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":18300.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17010.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":12555.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":17330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":13963.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":18823.46,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":23677.47,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":17603.42,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":20914.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":17603.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":17603.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":17603.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":17603.42,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":17603.42,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":17254.84,"methodology":"fee schedule"}]}]},{"description":"Level 1 Health and Behavi ","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":26.50,"maximum":56.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":27.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":27.04,"methodology":"fee 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"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":109815.85,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_percentage":46.80,"standard_charge_algorithm":"Reimbursement will be 46.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":147000.81,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":191706.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":104325.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":104325.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":191706.09,"methodology":"fee schedule"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":114122.36,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":107662.60,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":188409.55,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":181147.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":118852.55,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":161655.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":138598.15,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":105509.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":115494.10,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":113045.73,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":109815.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":109815.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":109815.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":109815.85,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":109815.85,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":115198.98,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":166877.03,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":166877.03,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":166877.03,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":113045.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":113045.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":113045.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":113045.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":113045.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":113045.73,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":107662.60,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":108739.23,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":107662.60,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":116275.61,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":146259.64,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":108739.23,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":118428.86,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":108739.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":108739.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":108739.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":108739.23,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":108739.23,"methodology":"fee schedule"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":12495.00,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":7036.00,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7485.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":7128.67,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":6281.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":6287.03,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12495.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10558.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":7128.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":7128.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":5553.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10796.58,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":7128.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":7057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":7057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":7057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":7057.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":7057.38,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":10336.57,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10092.06,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":7271.24,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":9291.14,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":7850.68,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":10238.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":6907.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":6907.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":10238.19,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":6923.87,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":7556.39,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":7128.67,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":9908.85,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":9674.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":6347.40,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":10703.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":7401.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":6986.10,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":6168.04,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":7485.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":7271.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":7271.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":7271.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":7271.24,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":7271.24,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":7627.68,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":11049.44,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":11049.44,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":11049.44,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":7485.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":7485.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":7485.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":7485.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":7485.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":7485.10,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":7128.67,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":7199.96,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":7128.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":35206.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":9880.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":11500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":9330.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":38957.99,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":49004.10,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":36432.93,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":39679.43,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":36432.93,"methodology":"fee 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If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18914.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12.  If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":10968.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":10968.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":15492.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12.  If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25791.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12.  If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":10968.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4523.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":4899.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5828.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":10859.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":10859.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":10859.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":10859.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":10859.10,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":15904.75,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15528.52,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":11188.17,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":15435.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":13165.83,"methodology":"fee schedule"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCEL","standard_charge_percentage":43.00,"standard_charge_algorithm":"Reimbursement will be 43% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"ACCOUNTABLEPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17169.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":10628.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":10628.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17169.77,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":11611.54,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":11626.92,"methodology":"fee schedule"},{"payer_name":"Independent Medical System","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":10968.79,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":10579.00,"methodology":"per diem"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":15246.62,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":16224.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_dollar":1540.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":10644.79,"methodology":"fee schedule"},{"payer_name":"National Healthcare Alliance","plan_name":"EPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Solutions","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":16469.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":12413.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":10749.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":10344.00,"methodology":"fee schedule"},{"payer_name":"Physicians Cooperative of Texas","plan_name":"WC","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Physicians, INC","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":11517.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":11188.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":11188.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":11188.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":11188.17,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":11188.17,"methodology":"fee schedule"},{"payer_name":"Rockport Workers Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":11736.61,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical","plan_name":"WORKERSCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":17001.62,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":17001.62,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":17001.62,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":11517.23,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":11517.23,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":11517.23,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":11517.23,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":11517.23,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":11517.23,"methodology":"fee schedule"},{"payer_name":"Texas Athletic Network","plan_name":"Premier","standard_charge_dollar":250.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"PremierPlus","standard_charge_dollar":750.00,"methodology":"other","additional_payer_notes":"Other Payment Notes: Per the billed unit for the service."},{"payer_name":"Texas Athletic Network","plan_name":"TexasCustomUC","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Childrens Healthplans","plan_name":"CHIP","standard_charge_percentage":27.03,"standard_charge_algorithm":"Reimbursement will be 27.03% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Texas Healthcare Foundation","plan_name":"WORKERSCOMP","standard_charge_dollar":10968.79,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":11078.48,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":10968.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6866.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6495 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10705.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":4515.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $562458.00, reimbursement will be $4564 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":6499.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $6148 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":22.40,"standard_charge_algorithm":"Reimbursement will be 22.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":4411.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $563855.00, reimbursement will be $4501 per diem instead of the contracted rate."},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":11846.29,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WORKERSCOMP","standard_charge_dollar":14901.10,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":11078.48,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":12065.67,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":11078.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":11078.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":11078.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":11078.48,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":11078.48,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10859.10,"methodology":"fee schedule"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC ","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":31791.78,"payers_information":[{"payer_name":"Accountable Health Plans","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":18449.11,"methodology":"fee schedule"},{"payer_name":"Affiliated PPO","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19626.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":18692.11,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":19086.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":15714.26,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $454276.00, reimbursement will be the lesser of (a) 20.7% of billable gross charges, or (b) $5498 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12412.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $503561.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $10125 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10033.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $441225.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $9240 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCR","standard_charge_dollar":18692.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":18692.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":14342.95,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $386135.00, reimbursement will be the lesser of (a) 17.5% of billable gross charges, or (b) $4936 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":31791.78,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $565896.00, reimbursement will be the lesser of (a) 25.9% of billable gross charges, or (b) $11010 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"Traditional","standard_charge_percentage":37.80,"standard_charge_algorithm":"Reimbursement will be 37.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"COMMPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Beech Street","plan_name":"WCOMP","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":18692.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":4779.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":5175.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":6156.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":18505.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":18505.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":18505.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":18505.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":18505.19,"methodology":"fee schedule"},{"payer_name":"Coastal Comp","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":27103.56,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":26462.42,"methodology":"fee schedule"},{"payer_name":"Coventry National First Health","plan_name":"COMM","standard_charge_dollar":2663.00,"methodology":"per diem","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":19065.95,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":28232.88,"methodology":"fee schedule"},{"payer_name":"Galaxy Health Network","plan_n