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charges"},{"payer_name":"Emerging Therapy Solutions","plan_name":"MGMCR","standard_charge_percentage":46.00,"standard_charge_algorithm":"Reimbursement will be 46% of billable gross charges.","estimated_amount":34.04,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"COMM","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":33.52,"methodology":"percent of total billed charges"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":55.50,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_percentage":19.60,"standard_charge_algorithm":"Reimbursement will be 19.6% of billable gross charges.","estimated_amount":14.50,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.30,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":40.70,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":38.48,"standard_charge_algorithm":"Reimbursement will be 38.48% of billable gross charges.","estimated_amount":28.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":38.48,"standard_charge_algorithm":"Reimbursement will be 38.48% of billable gross charges.","estimated_amount":28.48,"methodology":"percent of total billed charges"},{"payer_name":"Imperial Insurance","plan_name":"MGMCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges.","estimated_amount":14.06,"methodology":"percent of total billed charges"},{"payer_name":"Integrated Medical Systems","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":51.80,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":59.20,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"LOCALGOV","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":59.20,"methodology":"percent of total billed charges"},{"payer_name":"Medical Care Referral Group","plan_name":"EPO","standard_charge_percentage":52.00,"standard_charge_algorithm":"Reimbursement will be 52% of billable gross charges.","estimated_amount":38.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":48.10,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":51.80,"methodology":"percent of total billed charges"},{"payer_name":"National Provider Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":66.60,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":8.14,"methodology":"percent of total billed charges"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":48.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":44.40,"methodology":"percent of total billed charges"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":51.80,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":25.90,"methodology":"percent of total billed charges"},{"payer_name":"Sheriff's Dept El Paso County Detention","plan_name":"LOCALGOV","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.00,"methodology":"percent of total billed charges"},{"payer_name":"SouthWest Medical Provider Network","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":40.70,"methodology":"percent of total billed charges"},{"payer_name":"Superior Health Plan","plan_name":"MGMCD","standard_charge_percentage":6.00,"standard_charge_algorithm":"Reimbursement will be 6% of billable gross charges not to exceed $1800.","estimated_amount":4.44,"methodology":"percent of total billed charges"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":46.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":29.40,"standard_charge_algorithm":"Reimbursement will be 29.4% of billable gross charges.","estimated_amount":21.76,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":60.68,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":70.30,"methodology":"percent of total billed charges"},{"payer_name":"Ysleta Del Sur Pueblo","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.00,"methodology":"percent of total billed charges"}]}]},{"description":"CEMENT BN PMMA 40GM ","code_information":[{"code":"881864","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3063.00,"discounted_cash":3063.00,"payers_information":[{"payer_name":"Arcadian Health Plan","plan_name":"MCR","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2450.40,"methodology":"percent of total billed charges"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":520.71,"methodology":"percent of total billed charges"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2297.25,"methodology":"percent of total billed charges"},{"payer_name":"Emerging Therapy Solutions","plan_name":"MGMCR","standard_charge_percentage":46.00,"standard_charge_algorithm":"Reimbursement will be 46% of billable gross charges.","estimated_amount":1408.98,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"COMM","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":1387.54,"methodology":"percent of total billed charges"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2297.25,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_percentage":19.60,"standard_charge_algorithm":"Reimbursement will be 19.6% of billable gross charges.","estimated_amount":600.35,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1378.35,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":1684.65,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2450.40,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"LOCALGOV","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2450.40,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":765.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1990.95,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2144.10,"methodology":"percent of total billed charges"},{"payer_name":"National Provider Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2756.70,"methodology":"percent of total billed charges"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1990.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1837.80,"methodology":"percent of total billed charges"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2144.10,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":1072.05,"methodology":"percent of total billed charges"},{"payer_name":"Sheriff's Dept El Paso County Detention","plan_name":"LOCALGOV","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1531.50,"methodology":"percent of total billed charges"},{"payer_name":"SouthWest Medical Provider Network","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":1684.65,"methodology":"percent of total billed charges"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":1929.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1378.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":29.40,"standard_charge_algorithm":"Reimbursement will be 29.4% of billable gross charges.","estimated_amount":900.52,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":2511.66,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":2909.85,"methodology":"percent of total billed charges"},{"payer_name":"Ysleta Del Sur Pueblo","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1531.50,"methodology":"percent of total billed charges"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITH CC ","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":439.50,"maximum":14994.79,"payers_information":[{"payer_name":"Accountable Partners Healthcare Networks","plan_name":"EPO","standard_charge_dollar":4650.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Advantage Care Network","plan_name":"PPO","standard_charge_dollar":6776.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":10422.43,"methodology":"fee schedule"},{"payer_name":"Affiliated Healthcare","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":"Alignment Health Plan","plan_name":"MGMCR<3000","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health Plan","plan_name":"MGMCR>3000","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan of Texas","plan_name":"MGMCRHMO","standard_charge_dollar":11087.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DUALELIGIBLE","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"Arcadian Health Plan","plan_name":"MCR","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueAdvantage","standard_charge_dollar":11120.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $225668.00, reimbursement will be the lesser of (a) 27.8% of billable gross charges, or (b) $8192 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":13755.74,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $304028.00, reimbursement will be the lesser of (a) 27.9% of billable gross charges, or (b) $13023 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13571.63,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $312980.00, reimbursement will be the lesser of (a) 25.8% of billable gross charges, or (b) $12246 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MCD","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPOS","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPPO","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13939.85,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $295075.00, reimbursement will be the lesser of (a) 29.9% of billable gross charges, or (b) $13799 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"TriWest","standard_charge_dollar":10348.52,"methodology":"fee schedule"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_dollar":10454.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":12650.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13422.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRHMO","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPOS","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPPO","standard_charge_dollar":10559.71,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":14994.79,"methodology":"fee schedule"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10770.90,"methodology":"fee schedule"},{"payer_name":"El Paso First Health Plan","plan_name":"COMM","standard_charge_dollar":4010.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"First Health","plan_name":"COMM","standard_charge_dollar":6393.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3.  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"},{"payer_name":"Hospice of El Paso","plan_name":"COMM","standard_charge_dollar":439.50,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":10045.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"MGMCR","standard_charge_dollar":10190.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":10045.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Imperial Insurance","plan_name":"MGMCR","standard_charge_dollar":11193.29,"methodology":"fee schedule"},{"payer_name":"Integrated Medical Systems","plan_name":"COMM","standard_charge_dollar":717.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"MedCorp Southwest","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":"MedCorp Southwest","plan_name":"LOCALGOV","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":"Medical Care Referral Group","plan_name":"EPO","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":9142.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20249.29,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $312980.00, reimbursement will be the lesser of (a) 25.8% of billable gross charges, or (b) $12246 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MCD","standard_charge_dollar":12734.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":12734.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPOS","standard_charge_dollar":12734.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPPO","standard_charge_dollar":12734.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":24007.00,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $295075.00, reimbursement will be the lesser of (a) 29.9% of 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Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12988.69,"methodology":"fee schedule"},{"payer_name":"El Paso First Health Plan","plan_name":"COMM","standard_charge_dollar":1487.00,"methodology":"per diem"},{"payer_name":"First Health","plan_name":"COMM","standard_charge_dollar":2618.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $85847.00, reimbursement will be 56.6% of billable gross charges instead of the contracted rate."},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_percentage":19.60,"standard_charge_algorithm":"Reimbursement will be 19.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","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":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_dollar":1433.00,"methodology":"per diem"},{"payer_name":"Hospice of El Paso","plan_name":"COMM","standard_charge_dollar":439.50,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"MGMCR","standard_charge_dollar":12288.32,"methodology":"fee schedule"},{"payer_name":"Imperial Insurance","plan_name":"MGMCR","standard_charge_dollar":13498.05,"methodology":"fee schedule"},{"payer_name":"Integrated Medical Systems","plan_name":"COMM","standard_charge_dollar":1477.00,"methodology":"per diem"},{"payer_name":"MedCorp Southwest","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":"MedCorp Southwest","plan_name":"LOCALGOV","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":"Medical Care Referral Group","plan_name":"EPO","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":23081.70,"methodology":"case rate"},{"payer_name":"Molina Healthcare","plan_name":"MCR","standard_charge_dollar":17700.27,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MME","standard_charge_dollar":17700.27,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MMP","standard_charge_dollar":17700.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPO","standard_charge_dollar":1500.00,"methodology":"case rate"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Provider 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":"Oscar","plan_name":"HIX","standard_charge_dollar":14226.79,"methodology":"fee schedule"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_dollar":1500.00,"methodology":"case rate"},{"payer_name":"Prime Health","plan_name":"WC","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":"Provider Partners Health Plan","plan_name":"DualEligible","standard_charge_dollar":12988.69,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":12988.69,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PFFS","standard_charge_dollar":12988.69,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"POS","standard_charge_dollar":12988.69,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PPO","standard_charge_dollar":12988.69,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"SNP","standard_charge_dollar":12988.69,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MCR","standard_charge_dollar":14007.41,"methodology":"fee schedule"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":13625.39,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical Provider Network","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":"St David’s Hospice","plan_name":"MGMCD","standard_charge_dollar":11460.61,"methodology":"fee schedule"},{"payer_name":"St David’s Hospice","plan_name":"MGMCR","standard_charge_dollar":11460.61,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"HIX","standard_charge_dollar":19737.72,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MGMCR","standard_charge_dollar":13370.71,"methodology":"fee schedule"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"FEDERAL","standard_charge_dollar":12734.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16963.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $9442 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":12428.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":48.40,"standard_charge_algorithm":"Reimbursement will be 48.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":10528.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $5725 per diem instead of the contracted rate."},{"payer_name":"Universal Health PFFS NC","plan_name":"MCR","standard_charge_dollar":13752.73,"methodology":"fee schedule"},{"payer_name":"USA Managed 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":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare of TX","plan_name":"MCRHMO","standard_charge_dollar":13370.71,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"PFFS","standard_charge_dollar":13370.71,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"POS","standard_charge_dollar":13370.71,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"PPO","standard_charge_dollar":13370.71,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"SNP","standard_charge_dollar":13370.71,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":12670.34,"methodology":"fee schedule"},{"payer_name":"Western Sky Community Care","plan_name":"MGMCR","standard_charge_dollar":13370.71,"methodology":"fee schedule"},{"payer_name":"Ysleta Del Sur Pueblo","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"CK MB FRACTION ","code_information":[{"code":"808079","type":"CDM"},{"code":"82553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":1474.00,"discounted_cash":1474.00,"payers_information":[{"payer_name":"Accountable Partners Healthcare Networks","plan_name":"EPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":810.70,"methodology":"percent of total billed charges"},{"payer_name":"Advantage Care Network","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":884.40,"methodology":"percent of total billed charges"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":250.58,"methodology":"percent of total billed charges"},{"payer_name":"DANMARK - 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charges"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1105.50,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_percentage":19.60,"standard_charge_algorithm":"Reimbursement will be 19.6% of billable gross charges.","estimated_amount":288.90,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":663.30,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross 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","code_information":[{"code":"461456","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":6989.00,"discounted_cash":6989.00,"payers_information":[{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1188.13,"methodology":"percent of total billed charges"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":5241.75,"methodology":"percent of total billed charges"},{"payer_name":"Emerging Therapy Solutions","plan_name":"MGMCR","standard_charge_percentage":46.00,"standard_charge_algorithm":"Reimbursement will be 46% of billable gross charges.","estimated_amount":3214.94,"methodology":"percent of total billed charges"},{"payer_name":"First 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charges"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4892.30,"methodology":"percent of total billed charges"},{"payer_name":"National Provider Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6290.10,"methodology":"percent of total billed charges"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4542.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4193.40,"methodology":"percent of total billed charges"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4892.30,"methodology":"percent of total billed charges"},{"payer_name":"Sheriff's Dept El Paso County Detention","plan_name":"LOCALGOV","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3494.50,"methodology":"percent of total billed charges"},{"payer_name":"SouthWest Medical Provider Network","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":3843.95,"methodology":"percent of total billed charges"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross 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charges"},{"payer_name":"SouthWest Medical Provider Network","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":9994.05,"methodology":"percent of total billed charges"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":11447.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8176.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":29.40,"standard_charge_algorithm":"Reimbursement will be 29.4% of billable gross charges.","estimated_amount":5342.27,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":14900.22,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":17262.45,"methodology":"percent of total billed charges"},{"payer_name":"Ysleta Del Sur Pueblo","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9085.50,"methodology":"percent of total billed charges"}]}]},{"description":"PLATE UNI-CP 4HL L20 ","code_information":[{"code":"851723","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":44183.00,"discounted_cash":44183.00,"payers_information":[{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":7511.11,"methodology":"percent of total billed charges"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":33137.25,"methodology":"percent of total billed charges"},{"payer_name":"Emerging Therapy Solutions","plan_name":"MGMCR","standard_charge_percentage":46.00,"standard_charge_algorithm":"Reimbursement will be 46% of billable gross charges.","estimated_amount":20324.18,"methodology":"percent of total billed charges"},{"payer_name":"First 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charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":24300.65,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":35346.40,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"LOCALGOV","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":35346.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":28718.95,"methodology":"percent of total billed charges"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":30928.10,"methodology":"percent of total billed charges"},{"payer_name":"National Provider Network","plan_name":"COMM","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39764.70,"methodology":"percent of total billed charges"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":28718.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":26509.80,"methodology":"percent of total billed charges"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":30928.10,"methodology":"percent of total billed charges"},{"payer_name":"Sheriff's Dept El Paso County Detention","plan_name":"LOCALGOV","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22091.50,"methodology":"percent of total billed charges"},{"payer_name":"SouthWest Medical Provider Network","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":24300.65,"methodology":"percent of total billed charges"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross 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be 19.6% of billable gross charges.","estimated_amount":2572.50,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5906.25,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":7218.75,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":10500.00,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp 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charges"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":8531.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":7875.00,"methodology":"percent of total billed charges"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":9187.50,"methodology":"percent of total billed charges"},{"payer_name":"Sheriff's Dept El Paso County Detention","plan_name":"LOCALGOV","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6562.50,"methodology":"percent of total billed charges"},{"payer_name":"SouthWest Medical Provider Network","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":7218.75,"methodology":"percent of total billed charges"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":8268.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5906.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":29.40,"standard_charge_algorithm":"Reimbursement will be 29.4% of billable gross charges.","estimated_amount":3858.75,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"PPO","standard_charge_percentage":82.00,"standard_charge_algorithm":"Reimbursement will be 82% of billable gross charges.","estimated_amount":10762.50,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":12468.75,"methodology":"percent of total billed charges"},{"payer_name":"Ysleta Del Sur Pueblo","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6562.50,"methodology":"percent of total billed charges"}]}]},{"description":"PLEURAL EFFUSION WITH CC ","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":439.50,"maximum":18121.20,"payers_information":[{"payer_name":"Accountable Partners 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of Texas","plan_name":"MGMCRHMO","standard_charge_dollar":10458.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Amerigroup","plan_name":"DUALELIGIBLE","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"Arcadian Health Plan","plan_name":"MCR","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueAdvantage","standard_charge_dollar":7995.68,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $225668.00, reimbursement will be the lesser of (a) 27.8% of billable gross charges, or (b) $8192 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":16069.86,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $304028.00, reimbursement will be the lesser of (a) 27.9% of billable gross charges, or (b) $13023 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14705.40,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $312980.00, reimbursement will be the lesser of (a) 25.8% of billable gross charges, or (b) $12246 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MCD","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPOS","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPPO","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17434.32,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $295075.00, reimbursement will be the lesser of (a) 29.9% of billable gross charges, or (b) $13799 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"TriWest","standard_charge_dollar":9761.65,"methodology":"fee schedule"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_dollar":9861.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRHMO","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPOS","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPPO","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":14144.44,"methodology":"fee schedule"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement 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Healthcare","plan_name":"MME","standard_charge_dollar":13845.61,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MMP","standard_charge_dollar":13845.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPO","standard_charge_dollar":1300.00,"methodology":"case rate"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Provider 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":"Oscar","plan_name":"HIX","standard_charge_dollar":10423.49,"methodology":"fee schedule"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_dollar":1300.00,"methodology":"case rate"},{"payer_name":"Prime Health","plan_name":"WC","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":"Provider Partners Health Plan","plan_name":"DualEligible","standard_charge_dollar":10160.09,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":10160.09,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PFFS","standard_charge_dollar":10160.09,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"POS","standard_charge_dollar":10160.09,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PPO","standard_charge_dollar":10160.09,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"SNP","standard_charge_dollar":10160.09,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MCR","standard_charge_dollar":10956.96,"methodology":"fee schedule"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":10658.13,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical Provider Network","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":"St David’s Hospice","plan_name":"MGMCD","standard_charge_dollar":8964.78,"methodology":"fee schedule"},{"payer_name":"St David’s Hospice","plan_name":"MGMCR","standard_charge_dollar":8964.78,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"HIX","standard_charge_dollar":15439.35,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MGMCR","standard_charge_dollar":10458.91,"methodology":"fee schedule"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"FEDERAL","standard_charge_dollar":9960.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11024.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $9442 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":9721.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":48.40,"standard_charge_algorithm":"Reimbursement will be 48.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":7475.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $5725 per diem instead of the contracted rate."},{"payer_name":"Universal Health PFFS NC","plan_name":"MCR","standard_charge_dollar":10757.74,"methodology":"fee schedule"},{"payer_name":"USA Managed 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":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare of TX","plan_name":"MCRHMO","standard_charge_dollar":10458.91,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"PFFS","standard_charge_dollar":10458.91,"methodology":"fee 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"},{"payer_name":"Amerigroup","plan_name":"DUALELIGIBLE","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"Arcadian Health Plan","plan_name":"MCR","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueAdvantage","standard_charge_dollar":27766.19,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $225668.00, reimbursement will be the lesser of (a) 27.8% of billable gross charges, or (b) $8192 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":55804.99,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $304028.00, reimbursement will be the lesser of (a) 27.9% of billable gross charges, or (b) $13023 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":51066.70,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $312980.00, reimbursement will be the lesser of (a) 25.8% of billable gross charges, or (b) $12246 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MCD","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPOS","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPPO","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":60543.29,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $295075.00, reimbursement will be the lesser of (a) 29.9% of billable gross charges, or (b) $13799 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"TriWest","standard_charge_dollar":28902.61,"methodology":"fee schedule"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_dollar":29197.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":8841.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":9380.00,"methodology":"per diem"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRHMO","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPOS","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPPO","standard_charge_dollar":29492.46,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":41879.29,"methodology":"fee schedule"},{"payer_name":"DANMARK - 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"},{"payer_name":"Amerigroup","plan_name":"DUALELIGIBLE","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"Arcadian Health Plan","plan_name":"MCR","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueAdvantage","standard_charge_dollar":11560.41,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $225668.00, reimbursement will be the lesser of (a) 27.8% of billable gross charges, or (b) $8192 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":23234.32,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $304028.00, reimbursement will be the lesser of (a) 27.9% of billable gross charges, or (b) $13023 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":21261.54,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $312980.00, reimbursement will be the lesser of (a) 25.8% of billable gross charges, or (b) $12246 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MCD","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPOS","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPPO","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25207.10,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $295075.00, reimbursement will be the lesser of (a) 29.9% of billable gross charges, or (b) $13799 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"TriWest","standard_charge_dollar":13040.97,"methodology":"fee schedule"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_dollar":13174.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRHMO","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPOS","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPPO","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":18896.10,"methodology":"fee schedule"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13573.25,"methodology":"fee schedule"},{"payer_name":"El Paso First Health Plan","plan_name":"COMM","standard_charge_dollar":1487.00,"methodology":"per diem"},{"payer_name":"First Health","plan_name":"COMM","standard_charge_dollar":2618.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $85847.00, reimbursement will be 56.6% of billable gross charges instead of the contracted rate."},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_percentage":19.60,"standard_charge_algorithm":"Reimbursement will be 19.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","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":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_dollar":1433.00,"methodology":"per diem"},{"payer_name":"Hospice of El Paso","plan_name":"COMM","standard_charge_dollar":439.50,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"MGMCR","standard_charge_dollar":12841.36,"methodology":"fee schedule"},{"payer_name":"Imperial Insurance","plan_name":"MGMCR","standard_charge_dollar":14105.54,"methodology":"fee schedule"},{"payer_name":"Integrated Medical Systems","plan_name":"COMM","standard_charge_dollar":1477.00,"methodology":"per diem"},{"payer_name":"MedCorp Southwest","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":"MedCorp Southwest","plan_name":"LOCALGOV","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":"Medical Care Referral Group","plan_name":"EPO","standard_charge_dollar":1250.00,"methodology":"per diem"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_dollar":24108.50,"methodology":"case rate"},{"payer_name":"Molina Healthcare","plan_name":"MCR","standard_charge_dollar":18496.88,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MME","standard_charge_dollar":18496.88,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MMP","standard_charge_dollar":18496.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPO","standard_charge_dollar":1500.00,"methodology":"case rate"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Provider 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":"Oscar","plan_name":"HIX","standard_charge_dollar":15012.78,"methodology":"fee schedule"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_dollar":1500.00,"methodology":"case rate"},{"payer_name":"Prime Health","plan_name":"WC","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":"Provider Partners Health Plan","plan_name":"DualEligible","standard_charge_dollar":13573.25,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":13573.25,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PFFS","standard_charge_dollar":13573.25,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"POS","standard_charge_dollar":13573.25,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PPO","standard_charge_dollar":13573.25,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"SNP","standard_charge_dollar":13573.25,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MCR","standard_charge_dollar":14637.82,"methodology":"fee schedule"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":14238.61,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical Provider Network","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":"St David’s Hospice","plan_name":"MGMCD","standard_charge_dollar":11976.40,"methodology":"fee schedule"},{"payer_name":"St David’s Hospice","plan_name":"MGMCR","standard_charge_dollar":11976.40,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"HIX","standard_charge_dollar":20626.02,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MGMCR","standard_charge_dollar":13972.47,"methodology":"fee schedule"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"FEDERAL","standard_charge_dollar":13307.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16963.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $9442 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":12987.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":48.40,"standard_charge_algorithm":"Reimbursement will be 48.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":10528.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $5725 per diem instead of the contracted rate."},{"payer_name":"Universal Health PFFS NC","plan_name":"MCR","standard_charge_dollar":14371.68,"methodology":"fee schedule"},{"payer_name":"USA Managed 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":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare of TX","plan_name":"MCRHMO","standard_charge_dollar":13972.47,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"PFFS","standard_charge_dollar":13972.47,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"POS","standard_charge_dollar":13972.47,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"PPO","standard_charge_dollar":13972.47,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"SNP","standard_charge_dollar":13972.47,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":13240.57,"methodology":"fee schedule"},{"payer_name":"Western Sky Community Care","plan_name":"MGMCR","standard_charge_dollar":13972.47,"methodology":"fee schedule"},{"payer_name":"Ysleta Del Sur Pueblo","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"TRAY CGL TRACH TUBE SZ8 ","code_information":[{"code":"740610","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8698.00,"discounted_cash":8698.00,"payers_information":[{"payer_name":"Accountable Partners Healthcare Networks","plan_name":"EPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":4783.90,"methodology":"percent of total billed charges"},{"payer_name":"Advantage Care Network","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5218.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"ASA","standard_charge_percentage":57.30,"standard_charge_algorithm":"Reimbursement will be 57.3% of billable gross charges.","estimated_amount":4983.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"COMM","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":4218.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Meritain","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":4218.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"OON","standard_charge_percentage":57.10,"standard_charge_algorithm":"Reimbursement will be 57.1% of billable gross charges.","estimated_amount":4966.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP-Exchange","standard_charge_percentage":30.70,"standard_charge_algorithm":"Reimbursement will be 30.7% of billable gross charges.","estimated_amount":2670.29,"methodology":"percent of total billed charges"},{"payer_name":"Arcadian Health 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charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":40.70,"standard_charge_algorithm":"Reimbursement will be 40.7% of billable gross charges.","estimated_amount":3540.09,"methodology":"percent of total billed charges"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":1478.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_percentage":35.70,"standard_charge_algorithm":"Reimbursement will be 35.7% of billable gross charges.","estimated_amount":3105.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":38.00,"standard_charge_algorithm":"Reimbursement will be 38% of billable gross charges.","estimated_amount":3305.24,"methodology":"percent of total billed charges"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6523.50,"methodology":"percent of total billed charges"},{"payer_name":"El Paso First Health Plan","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5218.80,"methodology":"percent of total billed charges"},{"payer_name":"El Paso First Health Plans","plan_name":"MGMCD","standard_charge_percentage":6.00,"standard_charge_algorithm":"Reimbursement will be 6% of billable gross charges.","estimated_amount":521.88,"methodology":"percent of total billed charges"},{"payer_name":"Emerging Therapy Solutions","plan_name":"MGMCR","standard_charge_percentage":46.00,"standard_charge_algorithm":"Reimbursement will be 46% of billable gross 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will be 6% of billable gross charges not to exceed $1800.","estimated_amount":521.88,"methodology":"percent of total billed charges"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":5479.74,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3914.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":29.40,"standard_charge_algorithm":"Reimbursement will be 29.4% of billable gross charges.","estimated_amount":2557.21,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed 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"},{"payer_name":"Amerigroup","plan_name":"DUALELIGIBLE","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"Arcadian Health Plan","plan_name":"MCR","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueAdvantage","standard_charge_dollar":41381.06,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $225668.00, reimbursement will be the lesser of (a) 27.8% of billable gross charges, or (b) $8192 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":83168.40,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $304028.00, reimbursement will be the lesser of (a) 27.9% of billable gross charges, or (b) $13023 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":76106.73,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $312980.00, reimbursement will be the lesser of (a) 25.8% of billable gross charges, or (b) $12246 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"MCD","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRHMO","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPOS","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MGMCRPPO","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":90230.07,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $295075.00, reimbursement will be the lesser of (a) 29.9% of billable gross charges, or (b) $13799 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"TriWest","standard_charge_dollar":40109.40,"methodology":"fee schedule"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_dollar":40518.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_dollar":28413.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":30146.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRHMO","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPOS","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"Clover Insurance Company","plan_name":"MCRPPO","standard_charge_dollar":40927.96,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":58117.70,"methodology":"fee schedule"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":41746.52,"methodology":"fee 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"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":39945.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":48.40,"standard_charge_algorithm":"Reimbursement will be 48.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":35447.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Universal Health PFFS NC","plan_name":"MCR","standard_charge_dollar":44202.20,"methodology":"fee schedule"},{"payer_name":"USA Managed 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":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare of TX","plan_name":"MCRHMO","standard_charge_dollar":42974.36,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"PFFS","standard_charge_dollar":42974.36,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"POS","standard_charge_dollar":42974.36,"methodology":"fee schedule"},{"payer_name":"WellCare of 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charges"},{"payer_name":"First Health","plan_name":"COMM","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":11888.53,"methodology":"percent of total billed charges"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":19683.00,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_percentage":19.60,"standard_charge_algorithm":"Reimbursement will be 19.6% of billable gross charges.","estimated_amount":5143.82,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11809.80,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":14434.20,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":20995.20,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"LOCALGOV","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":20995.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina Healthcare","plan_name":"HIX","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross 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","code_information":[{"code":"106990","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":82.00,"discounted_cash":82.00,"payers_information":[{"payer_name":"Accountable Partners Healthcare Networks","plan_name":"EPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":45.10,"methodology":"percent of total billed charges"},{"payer_name":"Advantage Care Network","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":49.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"ASA","standard_charge_percentage":57.30,"standard_charge_algorithm":"Reimbursement will be 57.3% of billable gross charges.","estimated_amount":46.99,"methodology":"percent of total billed 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billable gross charges.","estimated_amount":12780.00,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":11.00,"standard_charge_algorithm":"Reimbursement will be 11% of billable gross charges.","estimated_amount":1562.00,"methodology":"percent of total billed charges"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":9230.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":8520.00,"methodology":"percent of total billed charges"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross 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Healthcare Networks","plan_name":"EPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":431.75,"methodology":"percent of total billed charges"},{"payer_name":"Advantage Care Network","plan_name":"PPO","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":471.00,"methodology":"percent of total billed charges"},{"payer_name":"Bienvivir Senior Health","plan_name":"COMM","standard_charge_percentage":17.00,"standard_charge_algorithm":"Reimbursement will be 17% of billable gross charges.","estimated_amount":133.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"OpenAccessPlus","standard_charge_percentage":35.70,"standard_charge_algorithm":"Reimbursement will be 35.7% of billable gross charges.","estimated_amount":280.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":38.00,"standard_charge_algorithm":"Reimbursement will be 38% of billable gross charges.","estimated_amount":298.30,"methodology":"percent of total billed charges"},{"payer_name":"DANMARK - International Contract","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":588.75,"methodology":"percent of total billed charges"},{"payer_name":"El Paso First Health Plan","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":471.00,"methodology":"percent of total billed charges"},{"payer_name":"El Paso First Health Plans","plan_name":"MGMCD","standard_charge_percentage":6.00,"standard_charge_algorithm":"Reimbursement will be 6% of billable gross charges.","estimated_amount":47.10,"methodology":"percent of total billed charges"},{"payer_name":"Emerging Therapy Solutions","plan_name":"MGMCR","standard_charge_percentage":46.00,"standard_charge_algorithm":"Reimbursement will be 46% of billable gross charges.","estimated_amount":361.10,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"COMM","standard_charge_percentage":45.30,"standard_charge_algorithm":"Reimbursement will be 45.3% of billable gross charges.","estimated_amount":355.61,"methodology":"percent of total billed charges"},{"payer_name":"Galaxy Health Network","plan_name":"COMM","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":588.75,"methodology":"percent of total billed charges"},{"payer_name":"Healthcare Highways","plan_name":"NarrowNetwork","standard_charge_percentage":19.60,"standard_charge_algorithm":"Reimbursement will be 19.6% of billable gross charges.","estimated_amount":153.86,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"Accel","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":353.25,"methodology":"percent of total billed charges"},{"payer_name":"HealthSmart Preferred Care","plan_name":"COMM","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":431.75,"methodology":"percent of total billed charges"},{"payer_name":"Integrated Medical Systems","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":549.50,"methodology":"percent of total billed charges"},{"payer_name":"MedCorp Southwest","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross 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WITHOUT CC/MCC ","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":439.50,"maximum":29215.86,"payers_information":[{"payer_name":"Accountable Partners Healthcare Networks","plan_name":"EPO","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":"Advantage Care Network","plan_name":"PPO","standard_charge_dollar":2512.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"MCR","standard_charge_dollar":14751.86,"methodology":"fee schedule"},{"payer_name":"Affiliated Healthcare","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":"Alignment Health Plan","plan_name":"MGMCR<3000","standard_charge_dollar":14946.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health Plan","plan_name":"MGMCR>3000","standard_charge_dollar":14946.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan of Texas","plan_name":"MGMCRHMO","standard_charge_dollar":15693.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Amerigroup","plan_name":"DUALELIGIBLE","standard_charge_dollar":14946.16,"methodology":"fee schedule"},{"payer_name":"Arcadian Health Plan","plan_name":"MCR","standard_charge_dollar":14946.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueAdvantage","standard_charge_dollar":13398.90,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $225668.00, reimbursement will be the lesser of (a) 27.8% of billable gross charges, or (b) $8192 multiplied by the number of medically necessary days."},{"payer_name":"BCBS","plan_name":"EPOSOA","standard_charge_dollar":26929.34,"methodology":"fee schedule","additional_payer_notes":" If billable gross charges exceed threshold of $304028.00, reimbursement will be the lesser of (a) 27.9% of billable gross charges, or (b) $13023 multiplied by the number of medically necessary 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schedule"},{"payer_name":"Molina Healthcare","plan_name":"MME","standard_charge_dollar":20775.16,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MMP","standard_charge_dollar":20775.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPO","standard_charge_dollar":1500.00,"methodology":"case rate"},{"payer_name":"National Healthcare Alliance","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"National Provider 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":"Oscar","plan_name":"HIX","standard_charge_dollar":17260.70,"methodology":"fee schedule"},{"payer_name":"PHCS","plan_name":"PPO","standard_charge_dollar":1500.00,"methodology":"case rate"},{"payer_name":"Prime Health","plan_name":"WC","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":"Provider Partners Health Plan","plan_name":"DualEligible","standard_charge_dollar":15245.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"MedicareAdvantageHMO","standard_charge_dollar":15245.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PFFS","standard_charge_dollar":15245.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"POS","standard_charge_dollar":15245.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"PPO","standard_charge_dollar":15245.08,"methodology":"fee schedule"},{"payer_name":"Provider Partners Health Plan","plan_name":"SNP","standard_charge_dollar":15245.08,"methodology":"fee schedule"},{"payer_name":"Pyramid Life","plan_name":"MCR","standard_charge_dollar":16440.78,"methodology":"fee schedule"},{"payer_name":"SAMSA","plan_name":"COMM","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Shared Health","plan_name":"MGMCR","standard_charge_dollar":15992.39,"methodology":"fee schedule"},{"payer_name":"SouthWest Medical Provider Network","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":"St David’s Hospice","plan_name":"MGMCD","standard_charge_dollar":13451.54,"methodology":"fee schedule"},{"payer_name":"St David’s Hospice","plan_name":"MGMCR","standard_charge_dollar":13451.54,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"HIX","standard_charge_dollar":23166.55,"methodology":"fee schedule"},{"payer_name":"Superior Health Plan","plan_name":"MGMCR","standard_charge_dollar":15693.47,"methodology":"fee schedule"},{"payer_name":"Texas Workforce Commission","plan_name":"WCOMP","standard_charge_percentage":63.00,"standard_charge_algorithm":"Reimbursement will be 63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Healthcare Alliance","plan_name":"FEDERAL","standard_charge_dollar":14946.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16963.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $9442 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":14587.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":48.40,"standard_charge_algorithm":"Reimbursement will be 48.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"SmallGroup","standard_charge_dollar":10528.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $509130.00, reimbursement will be $5725 per diem instead of the contracted rate."},{"payer_name":"Universal Health PFFS NC","plan_name":"MCR","standard_charge_dollar":16141.85,"methodology":"fee schedule"},{"payer_name":"USA Managed 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":"USA Managed Care","plan_name":"WC","standard_charge_percentage":95.00,"standard_charge_algorithm":"Reimbursement will be 95% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare of TX","plan_name":"MCRHMO","standard_charge_dollar":15693.47,"methodology":"fee schedule"},{"payer_name":"WellCare of TX","plan_name":"PFFS","standard_charge_dollar":15693.47,"methodology":"fee 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