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Comp","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":315.70,"methodology":"percent of total billed charges"},{"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":344.40,"methodology":"percent of total billed charges"},{"payer_name":"Superior Health Plan","plan_name":"CHIP","standard_charge_percentage":7.00,"standard_charge_algorithm":"Reimbursement will be 7% of billable gross charges.","estimated_amount":40.18,"methodology":"percent of total billed charges"},{"payer_name":"Superior Health Plan","plan_name":"CHPFC","standard_charge_percentage":7.00,"standard_charge_algorithm":"Reimbursement will be 7% of billable gross charges.","estimated_amount":40.18,"methodology":"percent of total billed charges"},{"payer_name":"Superior Health 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","code_information":[{"code":"49659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4255.00,"maximum":11899.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":6391.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":6391.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":6391.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":5028.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":5028.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":5028.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":4665.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":4665.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":4665.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":5915.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":5915.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":5915.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":9237.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":10005.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":11899.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Fidelis SecureCare of TX","plan_name":"MGMCR","standard_charge_dollar":4505.00,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":5980.95,"methodology":"fee schedule"},{"payer_name":"Kelsey Seybold","plan_name":"MCR","standard_charge_dollar":4255.00,"methodology":"case 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logic."},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":5028.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":5028.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":5028.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":4665.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":4665.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":4665.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":5915.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":5915.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":5915.00,"methodology":"case 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charges"},{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_percentage":44.50,"standard_charge_algorithm":"Reimbursement will be 44.5% of billable gross charges.","estimated_amount":45.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_percentage":44.50,"standard_charge_algorithm":"Reimbursement will be 44.5% of billable gross charges.","estimated_amount":45.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_percentage":44.50,"standard_charge_algorithm":"Reimbursement will be 44.5% of billable gross charges.","estimated_amount":45.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_percentage":35.10,"standard_charge_algorithm":"Reimbursement will be 35.1% of billable gross charges.","estimated_amount":36.15,"methodology":"percent of total billed 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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":42803.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":37471.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":24627.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. 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schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.36,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":160.43,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":135.03,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":173.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":137.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":137.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":137.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":137.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":137.70,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":134.36,"methodology":"fee schedule"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":17035.88,"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":10848.01,"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":11540.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":10990.89,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":7928.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":6845.31,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":13083.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12183.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":10990.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":6319.42,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13693.55,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":10990.89,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":10880.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":10880.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":10880.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":10880.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":10880.98,"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":15936.79,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15559.80,"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":8011.79,"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":16502.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":9342.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":10771.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":7785.39,"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":11540.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":11210.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":11210.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":11210.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":11210.71,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":11210.71,"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":11760.25,"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":17035.88,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":17035.88,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":17035.88,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":11540.43,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":11540.43,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":11540.43,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":11540.43,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":11540.43,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":11540.43,"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":10990.89,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":11100.80,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":10990.89,"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":10727.11,"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":11870.16,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":11100.80,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":12089.98,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":11100.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":11100.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":11100.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":11100.80,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":11100.80,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10880.98,"methodology":"fee schedule"}]}]},{"description":"Angiotensin II ","code_information":[{"code":"82163","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.82,"maximum":128.39,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":128.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":128.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":128.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":101.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":101.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":101.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":93.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":93.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":93.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":118.72,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":68.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":61.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":8.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":74.28,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":22.21,"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":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":29.75,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"CHIP","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"CHIPPerinatal","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"STAR","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"STAR+PLUS","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":57.02,"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":20.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":20.52,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":21.14,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"Molina 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schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":13.80,"methodology":"fee schedule"},{"payer_name":"ProCare Advantage","plan_name":"MGMCR","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"COMM","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Renaissance IPA Radiology","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"EPO","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":7.28,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Superior Health 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Plan","plan_name":"MCR","standard_charge_dollar":33576.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":31978.07,"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":23478.71,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":13083.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12183.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":31978.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":21674.98,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":46967.50,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":31978.07,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":31658.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":31658.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":31658.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":31658.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":31658.29,"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":46368.20,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":45271.35,"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":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":48015.07,"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":31338.51,"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":33576.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. 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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":31210.60,"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":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":11694.87,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":8700.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":9227.11,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12576.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11519.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":11694.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":8123.77,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13182.14,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":11694.87,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":11577.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":11577.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":11577.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":11577.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":11577.92,"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":16957.56,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":16556.43,"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":8792.14,"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":17559.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":10252.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":11460.97,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":8543.69,"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":12279.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":11928.77,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":11928.77,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":11928.77,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":11928.77,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":11928.77,"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":12513.51,"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":18127.05,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":18127.05,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":18127.05,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":12279.61,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":12279.61,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":12279.61,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":12279.61,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":12279.61,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":12279.61,"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":11694.87,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":11811.82,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":11694.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6145.00,"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":11414.19,"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":6140.00,"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":3948.00,"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":12630.46,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":11811.82,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":12864.36,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":11811.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":11811.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":11811.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":11811.82,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":11811.82,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":11577.92,"methodology":"fee schedule"}]}]},{"description":"BURNS; M > 0 ","code_information":[{"code":"C2101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22803.87,"maximum":24945.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":24333.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24710.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":23298.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":23298.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":23298.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":23298.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":23298.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":22803.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":22803.87,"methodology":"fee schedule"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":24945.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":23062.73,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22968.60,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":23533.40,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":23298.07,"methodology":"fee schedule"}]}]},{"description":"C-peptide ","code_information":[{"code":"84681","type":"CPT"},{"code":"846810","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.95,"maximum":130.20,"gross_charge":421.00,"discounted_cash":421.00,"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 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":7386.50,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":3974.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":4664.13,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12576.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11519.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":7386.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":4106.41,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6663.32,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":7386.50,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":7312.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":7312.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":7312.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":7312.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":7312.64,"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":10710.43,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10457.07,"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":7534.23,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":5879.02,"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":4967.56,"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":6478.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":7157.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":7157.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6478.27,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":4381.11,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":7829.69,"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":7386.50,"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":10267.24,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":6559.08,"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":4016.35,"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":11090.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":4683.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":7238.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":3902.86,"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":7755.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":7534.23,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":7534.23,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":7534.23,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":7534.23,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":7534.23,"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":7903.56,"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":11449.08,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":11449.08,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":11449.08,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":7755.83,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":7755.83,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":7755.83,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":7755.83,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":7755.83,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":7755.83,"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":7386.50,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":7460.37,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":7386.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6145.00,"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":7209.22,"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":6140.00,"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":3948.00,"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":7977.42,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":7460.37,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":8125.15,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":7460.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":7460.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":7460.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":7460.37,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":7460.37,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":7312.64,"methodology":"fee schedule"}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC ","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":114767.00,"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":86679.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":86679.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":86679.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":68194.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":68194.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":68194.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":41388.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":63271.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":63271.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":63271.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":80231.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":80231.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":80231.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"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":44030.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":41933.84,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":41869.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":13083.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12183.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":41933.84,"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":41933.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":89082.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":96492.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":114767.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"Cigna Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":41514.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":41514.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":41514.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":41514.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":41514.50,"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":60804.07,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":59365.74,"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":42772.52,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":61934.74,"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":52332.60,"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":68247.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":40633.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":40633.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":68247.77,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":46154.48,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":44449.87,"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":41933.84,"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":58288.04,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":69099.13,"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":42311.76,"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":62963.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":49341.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":41095.16,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":41116.14,"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":44030.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":42772.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":42772.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":42772.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":42772.52,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":42772.52,"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":44869.21,"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":64997.45,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":64997.45,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":64997.45,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":44030.53,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":44030.53,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":44030.53,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":44030.53,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":44030.53,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":44030.53,"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":41933.84,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":42353.18,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":41933.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":68738.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"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":40927.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":51014.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":65060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"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":46986.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":45288.55,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":42353.18,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":46127.22,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":42353.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":42353.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":42353.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":42353.18,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":42353.18,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":41514.50,"methodology":"fee schedule"}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC ","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":66062.83,"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":31303.22,"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":33301.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":31715.52,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":30661.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":58849.75,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $477476.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $6868 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":58564.36,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $682847.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $11843 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":51062.33,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $682847.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $10638 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":31715.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":43471.12,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $405854.00, reimbursement will be the lesser of (a) 20.4% of billable gross charges, or (b) $6382 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":66062.83,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $682847.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $13047 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":31715.52,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":31398.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":31398.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":31398.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":31398.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":31398.36,"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":45987.50,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":44899.66,"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":30984.85,"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":47620.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":36132.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":31081.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":30109.30,"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":33301.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":32349.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":32349.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":32349.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":32349.83,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":32349.83,"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":33935.61,"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":49159.06,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":49159.06,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":49159.06,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":33301.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":33301.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":33301.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":33301.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":33301.30,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":33301.30,"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":31715.52,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":32032.68,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":31715.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":23362.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"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":30954.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":17339.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":22112.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"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":15969.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":34252.76,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":32032.68,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":34887.07,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":32032.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":32032.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":32032.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":32032.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":32032.68,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":31398.36,"methodology":"fee schedule"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETER ","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":107177.00,"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":86679.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":86679.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":86679.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":68194.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":68194.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":68194.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":40903.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":63271.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":63271.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":63271.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":80231.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":80231.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":80231.00,"methodology":"case rate","additional_payer_notes":"Days 0-15. "},{"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":43514.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":41442.37,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":41330.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":75554.61,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $477476.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $6868 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":75188.22,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $682847.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $11843 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":65556.69,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $682847.00, reimbursement will be the lesser of (a) 24.3% of billable gross charges, or (b) $10638 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":41442.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":55810.66,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $405854.00, reimbursement will be the lesser of (a) 20.4% of billable gross charges, or (b) $6382 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":84815.17,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $682847.00, reimbursement will be the lesser of (a) 25% of billable gross charges, or (b) $13047 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":41442.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":83190.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":90111.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":107177.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. 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"},{"payer_name":"Multiplan","plan_name":"SAVILITYNETWORK","standard_charge_dollar":41766.97,"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":62225.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":48705.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":40613.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":40586.75,"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":43514.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":42271.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":42271.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":42271.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":42271.22,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":42271.22,"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":51802.96,"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":64235.67,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":64235.67,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":64235.67,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":43514.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":43514.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":43514.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":43514.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":43514.49,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":43514.49,"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":41442.37,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":41856.79,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":41442.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":68262.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"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":40447.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":50662.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":64609.00,"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":46661.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":44757.76,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":41856.79,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":51802.96,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":41856.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":41856.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":41856.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":41856.79,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":41856.79,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":41027.95,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"D1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25579.82,"maximum":27982.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":27295.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27718.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":26134.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":26134.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":26134.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":26134.18,"methodology":"fee schedule"},{"payer_name":"Cigna 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Plan","plan_name":"MCRPOS","standard_charge_dollar":53.98,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":53.98,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":53.98,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":53.98,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":51.67,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":61.69,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":66.83,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":52.95,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":51.67,"methodology":"fee schedule"}]}]},{"description":"DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC ","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":21448.85,"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":13658.08,"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":14529.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":13837.97,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":11051.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":12240.48,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12576.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11519.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":13837.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":10776.80,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17487.13,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":13837.97,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":13699.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":13699.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":13699.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":13699.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":13699.59,"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":20065.06,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":19590.41,"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":14114.73,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":16347.03,"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":13812.65,"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":18013.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":13408.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":13408.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":18013.29,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":12182.00,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":14668.25,"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":13837.97,"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":19234.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":18238.00,"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":11167.75,"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":20777.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":13023.11,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":13561.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":10852.18,"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":14529.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":14114.73,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":14114.73,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":14114.73,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":14114.73,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":14114.73,"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":14806.63,"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":21448.85,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":21448.85,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":21448.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":14529.87,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":14529.87,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":14529.87,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":14529.87,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":14529.87,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":14529.87,"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":13837.97,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":13976.35,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":13837.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6145.00,"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":13505.86,"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":6140.00,"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":3948.00,"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":14945.01,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":13976.35,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":15221.77,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":13976.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":13976.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":13976.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":13976.35,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":13976.35,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":13699.59,"methodology":"fee schedule"}]}]},{"description":"DENTAL AND ORAL DISEASES WITH CC ","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":17793.85,"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":11330.66,"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":12053.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":11479.90,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":8464.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8589.71,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12576.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11519.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":11479.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":7562.58,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12271.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":11479.90,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":11365.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":11365.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":11365.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":11365.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":11365.10,"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":16645.85,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":16252.09,"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":11709.50,"methodology":"fee schedule"},{"payer_name":"Evry Health","plan_name":"BroadNetwork","standard_charge_dollar":12520.88,"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":10579.68,"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":13797.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":11124.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":11124.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13797.14,"methodology":"fee schedule"},{"payer_name":"Imagine Health","plan_name":"PPO","standard_charge_dollar":9330.70,"methodology":"case rate"},{"payer_name":"Imperial Insurance Co","plan_name":"MCR","standard_charge_dollar":12168.69,"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":11479.90,"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":15957.06,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":13969.25,"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":8553.85,"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":17237.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":9974.94,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":11250.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":8312.14,"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":12053.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":11709.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":11709.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":11709.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":11709.50,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":11709.50,"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":12283.49,"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":17793.85,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":17793.85,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":17793.85,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":12053.90,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":12053.90,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":12053.90,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":12053.90,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":12053.90,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":12053.90,"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":11479.90,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":11594.70,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":11479.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6145.00,"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":11204.38,"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":6140.00,"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":3948.00,"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":12398.29,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":11594.70,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":12627.89,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":11594.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":11594.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":11594.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":11594.70,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":11594.70,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":11365.10,"methodology":"fee schedule"}]}]},{"description":"Deoxyribonucleic acid (DNA) antibody; single stranded ","code_information":[{"code":"801110","type":"CDM"},{"code":"86226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.21,"maximum":75.72,"gross_charge":978.00,"discounted_cash":978.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":75.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":75.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":75.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":59.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":55.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":55.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":55.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":70.01,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":10.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":40.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":36.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":43.84,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Christus (USFHP)","plan_name":"TRICARE","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":57.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":62.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Community Health Choice","plan_name":"HIX","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"CHIP","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"CHIPPerinatal","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"STAR","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Community Health Choice MCD","plan_name":"STAR+PLUS","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":23.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MGMCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCD","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MedicareAdvantagePPOPFFS","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Humana Military","plan_name":"TRICARE","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Integranet Amerigroup IPA","plan_name":"MCR","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"CHIP","standard_charge_dollar":11.00,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STAR","standard_charge_dollar":11.00,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STARKIDS","standard_charge_dollar":11.00,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"STARPLUS","standard_charge_dollar":11.00,"methodology":"fee schedule"},{"payer_name":"OMNI Healthcare","plan_name":"WORKERSCOMP","standard_charge_dollar":25.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":33.30,"methodology":"fee 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Healthplans","plan_name":"STARKIDS","standard_charge_dollar":11.00,"methodology":"fee schedule"},{"payer_name":"Texas Health Network","plan_name":"MCD","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":13.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":15.94,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":13.35,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC ","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":250.00,"maximum":16772.63,"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":10680.38,"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":11362.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":10821.05,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":7741.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":8064.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":12576.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11519.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":10821.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":7100.53,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11521.77,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":10821.05,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":10712.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":10712.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":10712.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":10712.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":10712.84,"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":15690.52,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15319.36,"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":7823.52,"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":16247.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"BROAD","standard_charge_dollar":9123.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"MGMCR","standard_charge_dollar":10604.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"NARROW","standard_charge_dollar":7602.45,"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":11362.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"MCRHMO","standard_charge_dollar":11037.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PFFS","standard_charge_dollar":11037.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"POS","standard_charge_dollar":11037.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"PPO","standard_charge_dollar":11037.47,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan of Texas","plan_name":"SNP","standard_charge_dollar":11037.47,"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":11578.52,"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":16772.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"HMO","standard_charge_dollar":16772.63,"methodology":"fee schedule"},{"payer_name":"Superior","plan_name":"ValueHMO","standard_charge_dollar":16772.63,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"DualEligible","standard_charge_dollar":11362.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRHMO","standard_charge_dollar":11362.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPOS","standard_charge_dollar":11362.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRPPO","standard_charge_dollar":11362.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_dollar":11362.10,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_dollar":11362.10,"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":10821.05,"methodology":"fee schedule"},{"payer_name":"Texas Independent Health Plan","plan_name":"MCR","standard_charge_dollar":10929.26,"methodology":"fee schedule"},{"payer_name":"Triumph","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":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_dollar":10821.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6145.00,"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":10561.34,"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":6140.00,"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":3948.00,"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":11686.73,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":10929.26,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":11903.16,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":10929.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":10929.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":10929.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":10929.26,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":10929.26,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10712.84,"methodology":"fee schedule"}]}]},{"description":"DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed ","code_information":[{"code":"81161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119.97,"maximum":1745.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ASAHMO","standard_charge_dollar":1745.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPOS","standard_charge_dollar":1745.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"ASAPPO","standard_charge_dollar":1745.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMHMO","standard_charge_dollar":1374.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPOS","standard_charge_dollar":1374.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"COMMPPO","standard_charge_dollar":1374.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":281.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBHMO","standard_charge_dollar":1274.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPOS","standard_charge_dollar":1274.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NBPPO","standard_charge_dollar":1274.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONHMO","standard_charge_dollar":1613.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPOS","standard_charge_dollar":1613.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"OONPPO","standard_charge_dollar":1613.62,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MGMCD","standard_charge_dollar":253.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":292.95,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":279.00,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":234.36,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCDCHIPBH","standard_charge_dollar":234.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":139.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":926.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":842.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":279.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":119.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":1009.98,"methodology":"fee schedule"},{"payer_name":"CHC Harris Health","plan_name":"Indigent","standard_charge_dollar":279.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"CSN","standard_charge_dollar":1306.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":1417.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":1685.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":279.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":279.00,"methodology":"fee schedule"},{"payer_name":"Cigna 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charges"},{"payer_name":"Superior Health Plan","plan_name":"MCRSNP","standard_charge_percentage":9.77,"standard_charge_algorithm":"Reimbursement will be 9.77% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Superior Health Plan","plan_name":"PFFS","standard_charge_percentage":9.77,"standard_charge_algorithm":"Reimbursement will be 9.77% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"Veterans","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_percentage":9.35,"standard_charge_algorithm":"Reimbursement will be 9.35% of billable gross 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billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_percentage":9.58,"standard_charge_algorithm":"Reimbursement will be 9.58% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_percentage":9.58,"standard_charge_algorithm":"Reimbursement will be 9.58% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_percentage":9.58,"standard_charge_algorithm":"Reimbursement will be 9.58% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_percentage":9.58,"standard_charge_algorithm":"Reimbursement will be 9.58% of billable gross 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"},{"payer_name":"Amerigroup","plan_name":"DualEligible","standard_charge_dollar":42362.13,"methodology":"fee schedule"},{"payer_name":"Averde Health","plan_name":"Commercial","standard_charge_dollar":42339.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BAV","standard_charge_dollar":39130.02,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $332319.00, reimbursement will be the lesser of (a) 17.2% of billable gross charges, or (b) $5493 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":13083.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 24% of billable gross charges, or (b) $10761 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12183.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, 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":"MGMCRHMO","standard_charge_dollar":42362.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MyBlueHealth","standard_charge_dollar":36123.89,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $282472.00, reimbursement will be the lesser of (a) 14.5% of billable gross charges, or (b) $4934 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":78276.83,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $525268.00, reimbursement will be the lesser of (a) 23.4% of billable gross charges, or (b) $12282 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":42362.13,"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 Behavioral Health","plan_name":"COMMBH","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":"Cigna HealthSpring","plan_name":"MCRHMO","standard_charge_dollar":41938.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRPPO","standard_charge_dollar":41938.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCRSNP","standard_charge_dollar":41938.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MMP","standard_charge_dollar":41938.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"PFFS","standard_charge_dollar":41938.51,"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":61425.09,"methodology":"fee schedule"},{"payer_name":"Corvel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":59972.07,"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":41345.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndivExchange","standard_charge_dollar":56217.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"NationalAccount","standard_charge_dollar":71696.00,"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":51779.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Universal Healthcare Group","plan_name":"MCR","standard_charge_dollar":45751.10,"methodology":"fee schedule"},{"payer_name":"Van Lang IPA","plan_name":"MCR","standard_charge_dollar":42785.75,"methodology":"fee schedule"},{"payer_name":"Verda Health Plan","plan_name":"MCR","standard_charge_dollar":52952.66,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"MCRHMO","standard_charge_dollar":42785.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PFFS","standard_charge_dollar":42785.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"POS","standard_charge_dollar":42785.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"PPO","standard_charge_dollar":42785.75,"methodology":"fee schedule"},{"payer_name":"WellCare","plan_name":"SNP","standard_charge_dollar":42785.75,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":41938.51,"methodology":"fee 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